MONOPOLAR ELECTROCAUTERY VERSUS ULTRASONIC DISSECTION OF THE GALLBLADDER FROM THE GALLBLADDER BED IN LAPAROSCOPIC CHOLECYSTECTOMY

Authors

  • Shireen A A Ramzanali
  • Zia -ul- Islam
  • Syed Sagheer Hussain Shah

Abstract

Background: Gold standard treatment for symptomatic gall stones is laparoscopic cholecystectomy (LC). Ultrasonically activated devices have been used for gall bladder dissection in LC. Harmonic scalpel (HS) is the leading ultrasonically cutting coagulation device offering surgeons important benefits. The main aim of our study was to compare the surgical outcomes of LC performed by HS to that performed by conventional mono-polar diathermy (electro-cautery). Methods: This prospective randomized study was conducted in surgical department of Jinnah Postgraduate Medical Centre, Karachi, during May–October 2013. During this period we selected 92 patients with symptomatic gallstones who underwent LC; these patients were randomly recruited into two groups using sealed opaque envelopes. Group A underwent gallbladder dissection from its bed using mono-polar diathermy, while on the other hand in Group B the dissection was carried out using harmonic scalpel. The outcomes like gallbladder perforation with bile spillage, intra-operative bleeding and operative time were assessed. Results: The harmonic scalpel (HS) usage in surgery results in shorter operative time, it also leads to less gallbladder injury, bile leakage and stone spillage (due to minimal lateralization of heat energy) not only this it also leads to less intra-operative blood loss. Conclusion: Harmonic scalpel is a new innovation in gallbladder surgery it has multiple functions like cutting, coagulation, coaptaion and cavitation which have made it safe, handy, effective and reliable instrument.Keywords: Gall stones, cholecystectomy, electrocautery, monopolar, gall bladder

References

Diez J, Arozamena C, Gutierrez L, Bracco J, Mon A, Sanchez Almeyra R, et al. Lost Stones During Laparoscopic Cholecystectomy. HPB Surg 1998;11(2):108–9.

Peters JH, Gibbons GD, Innes JT, Nichols KE, Front ME, Roby SR et al. Complications of laparoscopic cholecystectomy. Surgery 1991;110:769–77.

Soper NJ, Dunnegan DL. Does intraoperative gallbladder perforation inluence the early outcome of laparoscopic cholecystectomy? Surg Laparosc Endosc 1991;1(3):156–61.

Strasberg SM, Eagon CJ, Drebin JA. The ‘hidden cystic duct’ syndrome and the infundibular technique of laparoscopic cholecystectomy-the danger of the false infundibulum. J Am Coll Surg 2000;191:661–7.

Rosenberg J, Leinskold T. Dome down laparoscopic cholecystectomy. Scand J Surg 2004;93:48–51.

Janssen IM, Swank DJ, Boonstra O, Knipscheer BC, Klinkenbijl JH, van Goor H. Randomized clinical trial of ultrasonic versuselectrocautery dissection of the gallbladder in laparoscopic cholecystectomy. Br J Surg 2003;90:799–803.

Amaral JF. Laparoscopic cholecystectomy in 200 consecutive patients using an ultrasonically activated scalpel. Surg Laparosc Endosc 1995;5:255–62.

Power C, Maguire D, McAnena OJ, Calleary J. Use of the ultrasonic dissecting scalpel in laparoscopic cholecystectomy. Surg Endosc 2000;14:1070–3.

Wetter LA, Payne JH, Kirshenbaum G, Podoll EF, Bachinsky T, Way LW. The ultrasonic dissector facilitates laparoscopic cholecystectomy. Arch Surg 1992;127:1195–98.

Hui TT, Giurgiu DI, Margulies DR, Takagi S, Iida A, Phillips EH. Iatrogenic gallbladder perforation during laparoscopic cholecystectomy: etiology and sequelae. Am Surg 1999;65:944–8.

Tsimoyiannis EC, Jabarin M, Glantzounis G, Lekkas ET, Siakas P, Stefanaki-Nikou S. Laparoscopic cholecystectomy using ultrasonically activated coagulating shears. Surg Laparosc Endosc 1998;8:421–4.

Mahabaleshwar V, Kaman L, Iqbal J, Singh R. Monopolarelectrocautery versus ultrasonic dissection of the gallbladder from the gallbladder bed in laparoscopic cholecystectomy. Can J Surg 2012;55:307–11.

Khan MW, Aziz MM. Experience in laparoscopic cholecystectomy. Mymensingh Med J 2010;19(1):77–84.

Westervelt J. Clipless cholecystectomy: broadening the role of the harmonic scalpel. JSLS 2004;8:283–5.

Triantafyllidis I, Nikoloudis N, Sapidis N, Chrissidou M, Kalaitsidou I, Chrissidis T. Complications of laparoscopic cholecystectomy: our experience in a district general hospital. Surg Laparosc Endosc Percutan Tech 2009;19:449–58.

Bessa SS, Al-Fayoumi TA, Katri KM, Awad AT. Clipless laparoscopic cholecystectomy by ultrasonic dissection. J Laparoendosc Adv Surg Tech A 2008;18:593–8.

Carbonell AM, Joels CS, Kercher KW, Matthews BD, Sing RF, Heniford BT. Acomparison of laparoscopic bipolar vessel sealing devices in the hemostasis of small-, medium-, and largesized arteries. J Laparoendosc Adv Surg Tech A 2003;13:377–80.

Amarin NS. Harmonic Scalpel and Clipless Cholecystectomy. World J Laparosc Surg 2008;1:6–8.

Tebala GD. Three-port laparoscopic cholecystectomy by harmonic dissection without cystic duct and artery clipping. Am J Surg 2006;191:718–20.

Schmidbauer S, Hallfeldt KK, Sitzmann G, Kantelhardt T, Trupka A. Experience withultrasounds scissors and blades (UltraCision) in open and laparoscopic liver resection. Ann Surg 2002;235:27–30.

Catena F, Ansaloni L, Di Saverio S, Gazzotti F, Coccolini F, Pinna AD. The HAC Trial (Harmonic for Acute Cholecystitis) Study. Randomized, double-blind, controlled trial of Harmonic (H) versus Monopolar Diathermy (M) for laparoscopic cholecystectomy (LC) for acute cholecystitis (AC) in adults. Trials 2009;10:34.

Al Ghamdi AS, Khamis HS, El Said RE, Khairy GA. Laparoscopic cholecystectomy: The outcome with minimal conversion rate: Experience in a district hospital. Saudi J Gastroenterol 2003; 9:124–8.

Hüscher CG1, Lirici MM, Di Paola M, Crafa F, Napolitano C, Mereu A, et al. Laparoscopic cholecystectomy by ultrasonic dissection without cystic duct and artery ligature. Surg Endosc. 2003;17:442–51

Downloads

Published

2013-07-01