Page 8 - WALS Journal

World Journal of Laparoscopic Surgery, May-August 2008;1(2):6-8
Nazih Salameh Amarin
Harmonic Scalpel and Clipless

Cholecystectomy

Nazih Salameh Amarin
IBN Khaldun Street 41, Jabal Aman–amman, Jordan–11183

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Abstract technique described only in the European literature and, at
Background: The ultrasonically activated (Harmonic) scalpel has best, is only anecdotal in the United States This study was
proven to be an effective, efficient, and safe instrument for dissection undertaken to demonstrate the efficiency, safety , and cost
and hemostasis in both open and laparoscopic surgical procedures. effectiveness of the Harmonic scalpel as the sole instrument to
This Harmonic scalpel work on the tissue’s cutting and coagulating achieve complete hemobiliary stasis in the performance of
very effectively with the replacement the high frequency current, laparoscopic cholecystectomies.
which can be connected with diverse complications. The principle is
transforming of the electric power into mechanical longitudinal CASE REPORT
movement of the working part of the instrument, by piezoelectrical
transducer situated in the handpiece. The primary use of the Harmonic Patient ages ranged from 17 years to 73 years, and treatment
scalpel in laparoscopic cholecystectomies has been for the division of was rendered in both elective outpatient and acute inpatient
the cystic artery and liver bed dissection. Advancements in the settings. Operative procedures were performed with the patient
Harmonic scalpel blade tip now provide for the reliable ultrasonic under general anesthesia and placed in the standard supine,
division and closure of the cystic duct. crucifix, reverse-Trendelenburg position. Pneumoperitoneum
Keywords: Harmonic scalpel, Cholecystectomy. was achieved by either Veress needle or visually guided cannula
CO insufflation. All procedures were performed through 2
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INTRODUCTION operative ports and a camera port. Dissection of the gallbladder
was initiated at the Triangle of Calot with identification,
Designed as a safe alternative to electrocautery for the skeletization, and division of the cystic duct and artery.
hemostatic dissection of tissue, the ultrasonically activated Antegrade mobilization of the gallbladder from the liver bed
(Harmonic) scalpel was introduced into clinical use nearly a followed with subsequent removal of the specimen through the
decade ago. This innovative method of cutting tissue was based umbilicus. In all but 2 cases, closure and division of the cystic
upon the coagulating and cavitational effects provided by a duct and artery as well as mobilization of the gallbladder from
1,2
rapidly vibrating blade contacting various tissues. The the liver bed were accomplished solely with the Harmonic
resulting decrease in temperatures, smoke, and lateral tissue scalpel equipped with an LCS-C5 curved blade tip at a level 2
damage placed the Harmonic scalpel in contrast to the effects setting. Two patients with visibly large cystic ducts (greater
seen with the more traditional electrosurgery/cautery. In than 5 mm) underwent additional Endoloop closure of the duct
addition, the elimination of inadvertent, sometimes remnant. No intraoperative cholangiograms were performed.
unrecognized, electrical arcing injuries with their potentially Any patients presenting with clinical evidence of
hazardous sequelae supported the role of the Harmonic scalpel choledocholithiasis or biliary pancreatitis underwent
as a potentially safer instrument for tissue dissection. Since its preoperative endoscopic retrograde cholangiopancreatography
inception, the Harmonic scalpel has gained significant clinician (ERCP) evaluation and treatment. All patients were evaluated
acceptance and applications. Uses now range widely to include up to 4 weeks postoperatively in the office.
surgery of the head and neck, chest, liver, spleen, kidney,
adrenal glands, colon, rectum, gastroesophageal junction, and BACKGROUND
others. Although variously described in the literature, wide Laparoscopic cholecystectomy is frequently complicated by
acceptance and usage of the Harmonic scalpel for standard gallbladder perforation and loss of bile or stones into the
laparoscopic cholecystectomies is lacking among our American peritoneal cavity. The aim of this study was to compare the use
general surgeon colleagues. Clip and cautery techniques of ultrasonic dissection and electrocautery with respect to the
predominate. Furthermore, total Harmonic scalpel dissection in incidence of gallbladder perforation and intraoperative
the performance of a laparoscopic cholecystectomy is a consequences.

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