Monopolar electrocautery versus ultrasonic dissection of the gallbladder from the gallbladder bed in laparoscopic cholecystectomy: a randomized controlled trial

Mahabaleshwar, Varun; Kaman, Lileswar; Iqbal, Javid; Singh, Rajinder

doi:10.1503/cjs.000411

Cited by 26 publications

(30 citation statements)

References 16 publications

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“…Particularly, the same-day discharge rate was similar (87 %) in the study groups. Mean operative time in previous randomized studies comparing ultrasonic dissection method and diathermy dissection seems to be lower in ultrasonic dissection method (27-60 vs 34-65 min) in contrast to our study showing similar operating time in both study groups [7,8,15,16].…”

Section: Discussioncontrasting

confidence: 99%

“…Overall, intraoperative gallbladder perforations occur in 8.6-20 % during conventional diathermy dissection [25,26]. However, in randomized series comparing diathermy and ultrasonic dissection gallbladder perforations (40-51 vs 16-26 %) seems to occur less often with ultrasonic dissection [7, 15,16]. In our study, intraoperative perforations occurred more often in the ultrasonic group (27 vs. 20 %), although the difference was not statistically significant.…”

Section: Discussioncontrasting

confidence: 55%

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Day-care laparoscopic cholecystectomy with diathermy hook versus fundus-first ultrasonic dissection: a randomized study

et al. 2015

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Section: Discussioncontrasting

confidence: 99%

Section: Discussioncontrasting

confidence: 55%

Day-care laparoscopic cholecystectomy with diathermy hook versus fundus-first ultrasonic dissection: a randomized study

et al. 2015

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“…In various studies done previously, there is a significant difference in the operating time between the harmonic and electrocautery groups. This can be explained by the fact that the harmonic scalpel is a multifunctional instrument [ 1 - 2 , 7 ]. It replaces four instruments routinely used in conventional LC, namely, the dissector, clip applier, scissors, and electrosurgical hook/spatula.…”

Section: Discussionmentioning

confidence: 99%

Harmonic Scalpel-Assisted Laparoscopic Cholecystectomy vs. Conventional Laparoscopic Cholecystectomy - A Non-randomized Control Trial

Kumar¹,

Sureshkumar²,

Ali³

et al. 2018

Cureus

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IntroductionLaparoscopic cholecystectomy (LC) is the most commonly done, minimally invasive surgical procedure. Routinely used electrocautery produces more smoke, which masks the operating field, thereby prolongs the surgery and posing an increased risk of gallbladder (GB) perforation. The titanium clips used for clipping the cystic artery and cystic duct have a risk of slippage, which may lead to bleeding, and an increased risk for bile leakage. In addition, it may act as a nidus for stone formation. Advanced energy sources, such as the harmonic scalpel, though expensive, may provide the advantage of shorter operating time by reducing smoke, bloodless dissection in the GB bed, lower risk of bleeding from the cystic artery due to secure vessel sealing, and avoiding the use of a larger number of titanium clips. However, evidence to substantiate this advantage is limited.AimTo compare the operating time and perioperative complications between conventional laparoscopic cholecystectomy (CLC) and harmonic scalpel assisted laparoscopic cholecystectomy (HLC).MethodologyAll consecutive patients who underwent elective LC were included. Patients with acute infection, impaired liver function tests, concomitant common bile duct calculi, chronic liver disease/cirrhosis, suspected GB carcinoma, and pregnant women were excluded from the study. Patients were allocated into two groups. In the CLC group, both the cystic duct and the cystic artery were divided after conventional titanium clip application and electrocautery was used for thermal energy. In the HLC group, the cystic duct was clipped with a titanium clip and the rest of the procedure was carried out using Harmonic Ace (Ethicon, New Jersey, United States) and Harmonic Hook (Ethicon, New Jersey, United States). Outcome parameters analyzed were operating time in minutes, post-operative pain using visual analogue scale (VAS) scoring, frequency and route of analgesic requirement after 24 hours, and intraoperative complications, including bleeding, bile duct injury, GB perforation, and surgical site infection (SSI) in the postoperative period, per the Centers for Disease Control (CDC) criteria.ResultsBoth the groups were comparable with respect to age, gender, body mass index (BMI), and the presence of comorbidity and an indication of cholecystectomy. The duration of surgery did not significantly differ between the groups (67.3 vs. 64.3 mins; p = 0.30). Other parameters, such as analgesic required on postoperative Day 1 (3.2 vs. 3; p = 0.67), VAS scores on Day 0 (4.55 vs. 4.65; p = 0.59), VAS scores on Day 1 (2.3 vs. 2.2; p = 0.84), superficial SSI (15% vs. 10%; p = 0.63), intraoperative GB perforation (30% vs. 20%; p = 0.71), and intraperitoneal drain (30% vs. 20%; p = 0.71) did not significantly differ between the groups.ConclusionHLC has no significant advantage over CLC with respect to operating time, postoperative pain, and perioperative complications.

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“…Several studies have demonstrated the clinical and surgical advantage of the Harmonic scalpel over conventional techniques in different surgical areas, including thyroidectomy [ 10 – 13 ], cholecystectomy [ 14 , 15 ], and colectomy [ 16 – 19 ]. Furthermore, this device has been widely used in both laparoscopic and open surgeries [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Gastrectomy and D2 Lymphadenectomy for Gastric Cancer: A Meta-Analysis Comparing the Harmonic Scalpel to Conventional Techniques

Cheng¹,

Hsiao²,

Clymer³

et al. 2015

International Journal of Surgical Oncology

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The ultrasonic Harmonic scalpel has demonstrated clinical and surgical benefits in dissection and coagulation. To evaluate its use in gastrectomy, we conducted a systematic review and meta-analysis of randomized controlled trials comparing the Harmonic scalpel to conventional techniques in gastrectomy for patients with gastric cancer. International databases were searched without language restrictions for comparisons in open or laparoscopic gastrectomy and lymphadenectomy. The meta-analysis used a random-effects model for all outcomes; continuous variables were analyzed for mean differences and dichotomous variables were analyzed for risk ratios. Sensitivity analyses were conducted for study quality, type of conventional technique, and imputation of study results. Ten studies (N = 935) met the inclusion criteria. Compared with conventional hemostatic techniques, the Harmonic scalpel demonstrated significant reductions in operating time (−27.5 min; P < 0.001), intraoperative blood loss (−93.2 mL; P < 0.001), and drainage volume (−138.8 mL; P < 0.001). Results were numerically higher for conventional techniques for hospital length of stay, complication risk, and transfusions but did not reach statistical significance. Results remained robust to sensitivity analyses. This meta-analysis demonstrates the clear advantages of using the Harmonic scalpel compared to conventional techniques, with improvements demonstrated across several outcome measures for patients undergoing gastrectomy and lymphadenectomy.

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Monopolar electrocautery versus ultrasonic dissection of the gallbladder from the gallbladder bed in laparoscopic cholecystectomy: a randomized controlled trial

Cited by 26 publications

References 16 publications

Day-care laparoscopic cholecystectomy with diathermy hook versus fundus-first ultrasonic dissection: a randomized study

Day-care laparoscopic cholecystectomy with diathermy hook versus fundus-first ultrasonic dissection: a randomized study

Harmonic Scalpel-Assisted Laparoscopic Cholecystectomy vs. Conventional Laparoscopic Cholecystectomy - A Non-randomized Control Trial

Gastrectomy and D2 Lymphadenectomy for Gastric Cancer: A Meta-Analysis Comparing the Harmonic Scalpel to Conventional Techniques

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