Page 76 - World Journal of Laparoscopic Surgery

RESEARCH ARTICLE
A Clinical Comparative Study of Bipolar Electrocautery vs

Clips for Cystic Artery during Laparoscopic Cholecystectomy

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Shaileshkumar M Emmi , Suhas DS 2

AbstrAct
Introduction: Since 1987, laparoscopic cholecystectomy has been regarded as the gold standard treatment for cholelithiasis. Surgical clips,
harmonic scalpel and ligature, or bipolar cautery can be used to control the cystic artery during this treatment. In this paper, we examine the
use of bipolar electrocautery vs clip ligation to control the cystic artery during laparoscopic cholecystectomy.
Method: This is a clinical comparative study that was carried out in total of 60 patients who underwent laparoscopic cholecystectomy conducted
for 3 year duration (2016–2019). The patients were monitored for postoperative hemorrhage and bile leak, as well as differences in hospital
stay length and postoperative sequelae.
Results: In our study, the cystic artery was controlled using bipolar electrocautery in 30 patients (group B) and by surgical clips in 30 patients
(group A). In both groups, the length of stay in the hospital and the duration of surgery were similar. In Group A, no incidences of intraoperative
hemorrhage or bile leak were documented, but Group B had two cases of bile leak and four cases of intraoperative cystic artery bleed.
Conclusion: We conclude that, especially in developing countries, bipolar diathermy and clip application are equally effective strategies for
hemostatic control of the cystic artery during laparoscopic cholecystectomy.
Keywords: Bipolar electrocautery, Clips, Cystic artery, Laparoscopic cholecystectomy.
World Journal of Laparoscopic Surgery (2022): 10.5005/jp-journals-10033-1500

IntroductIon 1,2 Department of General Surgery, SNMC and HSK Hospital, Bagalkot,
Mühe performed Germany’s first endoscopic cholecystectomy in Karnataka, India
1985. The National Institutes of Health (NIH) Consensus Development Corresponding Author: Suhas DS, Department of General Surgery,
Conference in 1992 concluded that for most individuals with SNMC and HSK Hospital, Bagalkot, Karnataka, India, Phone:
symptomatic gallstones, laparoscopic cholecystectomy provides +91 8971999037, e-mail: ds.suhas93@gmail.com
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a safe and effective treatment. Since then, laparoscopic How to cite this article: Emmi SM, Suhas DS. A Clinical Comparative
cholecystectomy has been regarded as the gold standard for Study of Bipolar Electrocautery vs Clips for Cystic Artery during
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cholelithiasis therapy. This new procedure was initially linked to Laparoscopic Cholecystectomy. World J Lap Surg 2022;15(1):74–76.
a large increase in morbidity, particularly iatrogenic biliary injury Source of support: Nil
and arterial bleeding. The right hepatic artery is the most common
source of cystic artery; however, it can also come from the common Conflict of interest: None
hepatic, celiac trunk, right gastric, superior mesenteric, and other
arteries. Because the cystic artery’s course and length in the Calot’s cholecystectomy from April 2015 to July 2017 (27 months) were
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triangle are variable, hemostasis of the cystic artery is essential included in the study.
because it can cause torrential hemorrhage if not ligated adequately The cystic artery was clipped with titanium clips in Group A
and is the most common cause of postoperative bleeding after to gain control. We have a standard practice of using two clips.
laparoscopic cholecystectomy. Clip application, bipolar diathermy, Bipolar diathermy was used to cauterize the cystic artery in group
monopolar diathermy, vascular sealing with ultrasonics, harmonics, B. All patients gave their informed consent. This study covered all
and other techniques are available for cystic artery control. Clips can patients with symptomatic gallstone disease. The study did not
slip, dislodge, migrate, internalize, and cause cystic duct necrosis, include patients with acute cholecystitis, empyema gallbladder,
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which can lead to bile leakage and other complications. Because it chronic renal failure, obstructive jaundice, choledocholithiasis,
is both inexpensive and widely available, bipolar electrocoagulation portal hypertension, pancreatitis, or suspected malignancies.
can be utilized to regulate the cystic artery. However, most surgeons In both groups, a single surgeon with at least 5 years of
are still opposed to using bipolar electrocautery in the Calot’s expertise in minimally invasive surgery conducted laparoscopic
triangle. As a result, in laparoscopic cholecystectomy, we contrasted cholecystectomy under general anesthesia after a preoperative
bipolar electrocautery with clip application to determine the safest workup. The surgery was carried out using a four-port procedure.
and least complicated method for hemostasis of the cystic artery. The surgeon stood to the left of the patient, the first assistant to the
right of the patient, and the laparoscopic video camera operator
MAterIAls And Methods to the left of the surgeon, according to the “American” procedure.
A retrospective observational study was carried out in SN Pneumoperitoneum was achieved with CO gas via a Veress needle,
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Medical College and HSK Hospital, Bagalkot. A total of 60 patients which was then replaced with a blindly inserted laparoscopic port.
(32 females and 28 males) who underwent elective laparoscopic The hepatocystic triangle, which is the ventral aspect of the area

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