Page 19 - World Journal of Laparoscopic Surgery

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10.5005/jp-journals-10033-1295
Clipped vs Clipless Laparoscopic Cholecystectomy using the Ultra sonically Activated (Harmonic) Scalpel
OriginaL articLe

Clipped vs Clipless Laparoscopic Cholecystectomy using

the Ultrasonically Activated (Harmonic) Scalpel

2
1 Mohammed Hamdy Abdelhady, Asaad F Salama

ABSTRACT INTRODUCTION
Introduction: Laparoscopic cholecystectomy (LC) is the “gold The surgical management of gallstones has been revo-
standard” in the treatment of symptomatic gallbladder lithiasis. lutionized after the advent of laparoscopic cholecystec-
Monopolar hook, i.e., used currently is associated with some
complications, such as the risk of thermal injuries and biliary tomy (LC). Laparoscopic cholecystectomy is the optimal
complications. The ultrasonically activated (harmonic) scalpel treatment for patients with symptomatic cholelithiasis.
has been increasingly used for dissection of the gallbladder and It has a positive impact on the postoperative quality of
for division of vessels and the cystic duct, because it reduces the patient’s life as well as optimal short- and long-term
the risk of thermal injuries with encouraging results.
results. 1
Materials and methods: In this prospective study, 60 patients The standard LC is commonly performed by means
with gallbladder stones were planned to do LC. Patients were of specialized instruments. The electrosurgical dissec-
randomly assigned to either group I, including 30 patients who
were subjected to traditional LC using cautery and clip applier, tor, hook, spatula, and/or scissors, using high-frequency
or to group II, including 30 planned for clipless cholecystectomy monopolar electrocautery, have been used in most centers
using harmonic (Ethicon Endosurgery Ultracision Harmonic for dissection of gallbladder and adhesions. Metal clips
Scalpel, Generator 300). were the most frequently used technique to achieve both
Results: Neither minor nor major bile leaks were encountered cystic duct and artery closure. Alternative techniques
in either groups. Similarly, no bile-duct injuries were encoun- for cystic duct closure have included sutures, either
tered in the present study. The incidence of gallbladder perfora- extracorporeal or intracorporeal knots. However, these
tion was less in group II. Operative time was significantly shorter
in group II (p = 0.032). Mean hospital stay was significantly less alternatives are technically more difficult and, therefore,
in group II (p = 0.046). No statistically significant difference was were used infrequently. 2
found in the incidence of postoperative complications between Several reports have revealed several injuries and
both groups. postoperative complications due to the current technol-
Conclusion: The harmonic shears are as safe and effective ogy and technique of LC. These include deep tissue
as the commonly used clip and cautery technique in achieving damage with possible distant tissue damage by the high-
safe closure and division of the cystic duct in the LC. Further, frequency electrocautery involving vascular and biliary
it provides a superior alternative to the currently used high-
frequency monopolar technology in terms of shorter operative structures in the vicinity of the cystic duct and artery,
time and lower incidence of gallbladder perforation. bile leakage due to slippage of the clips, and visceral and
Keywords: Clipless, Harmonic scalpel, Laparoscopic chole- solid organ injuries due to frequent instrument exchange,
cystectomy. which is sometimes performed without optic guidance. 3
The ultrasonically activated (harmonic) scalpel was
How to cite this article: Abdelhady MH, Salama AF. Clipped
vs Clipless Laparoscopic Cholecystectomy using the Ultra- designed as a safe alternative to electrocautery for the
sonically Activated (Harmonic) Scalpel. World J Lap Surg hemostatic dissection of tissue and was introduced into
2017;10(1):17-21. clinical use nearly two decades ago. This innovative
Source of support: Nil method of cutting tissue was based upon the coagulating
Conflict of interest: None and cavitational effects provided by a rapidly vibrating
blade contacting various tissues. 4
The resulting decrease in temperatures, smoke, and
1,2 Surgeon lateral tissue damage placed the harmonic scalpel in
1 Department of General and Laparoscopic Surgery, Jahra contrast to the effects seen with the more traditional
Hospital, Jahra, Kuwait electrocautery. In addition, the elimination of inadvertent,
2 Department of Hepatobiliary Surgery, Theodore Bilharz sometimes unrecognized, electrical arcing injuries with
Research Institute, Cairo, Egypt their potentially hazardous sequelae supported the role
Corresponding Author: Mohammed Hamdy Abdelhady of the harmonic scalpel as a potentially safer instrument
Surgeon, Department of General and Laparoscopic Surgery for tissue dissection. 5
Jahra Hospital, Jahra, Kuwait, Phone: +96565589000, e-mail: The replacement of scissors, dissector, and clips appli-
drhamdysurg@yahoo.com
cator with the harmonic scalpel gives the opportunity
World Journal of Laparoscopic Surgery, January-April 2017;10(1):17-21 17