Page 77 - World Journal of Laparoscopic Surgery

Bipolar Electrocautery vs Clips for Cystic Artery during Laparoscopic Cholecystectomy
surrounded by the gallbladder wall and cystic duct, the liver edge, Table 1: Demographic data of patients
and the common hepatic duct, was dissected; the cystic artery Variables Group A Group B p value
(and hence Calot’s triangle) is located within this space. By retracting
the gallbladder’s infundibulum inferiorly and laterally while keeping Age (years) 50.73 + −11.09 54.13 + −13.2 0.285
the fundus under traction in a superior and medial orientation, the Gender
hepatocystic triangle was maximum expanded. The cystic duct was Male 13 (43.3%) 15 (50%)
clipped with Ligaclip LT 300 in 30 cases after the Calot’s triangle was Female 17 (56.7%) 15 (50%)
dissected. On the cystic artery, one clip was placed distally and the
other proximally. Between the proximal and distal clips, the cystic Table 2: Intraoperative and postoperative parameter in both groups
artery was separated. A bipolar cautery was used to coagulate Variables Group A Group B p value
the artery in 30 individuals. Just lateral to the Calot’s lymph node, Intraoperative blood 0 4 (13.3%) 0.039
an artery was cauterized in spray mode. Any signs of bile leakage loss
and bleeding were noted over divided stumps of cystic duct and Bile leak 0 2 (7.7%) 0.155
artery. The gall bladder was evacuated through the umbilical port
after the cholecystectomy was performed according to usual Duration of operation 56.50 + −12.9 50.90 + −15.1 0.128
technique. Hemostasis was maintained during the procedure. The (minute)
derbis and blood clots were removed using suction. Any bile leaks or Hospital stay (days) 2.93 + −0.75 2.93 + −0.9
hemorrhages in the cystic duct and artery stump were re-examined. was initially linked to a large increase in morbidity, particularly
Bupivacaine was infused into each port incision for postoperative iatrogenic biliary injury and arterial bleeding. To avoid injury
analgesia. One large absorbable suture was used to seal the fascia to the extrahepatic biliary tree, the surgeon must rely on his
of the umbilical incision. Xylon 3–0 was used to close the other thorough understanding of Calot’s triangle modifications and
skin incisions. Any cases of postoperative bleeding or bile leak perform meticulous dissection. Various methods, such as clip
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were observed in the patients. A large bleed was defined as more application, monopolar and bipolar cautery, vascular sealers,
than 100 mL of fresh blood in the drain bag or abdominal cavity. and ultrasonic devices, can be used to manage the cystic artery
When all of the patients were deemed fit, they were discharged during the process.
from the hospital. The length of stay in the hospital as well as any We compared the results of electrocautery ligation of the cystic
postoperative complications were observed and recorded. All artery to those of surgical clip (Ligaclip) application in this study.
patients were monitored for six months, daily until the seventh In both groups, female preponderance was observed in the ratios
postoperative day, and thereafter once a month. of 1:1 and 1.3:1, which closely matched the demographic data
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Statistical Analyzes reported by Hugh et al. in their research of laparoscopic anatomy
SPSS 16.0 was used to statistically analyze the results. The of the cystic artery. In both groups, the length of stay in the hospital
mean ± standard deviation (SD) was used to express numerical data. and the duration of surgery were similar. In Group A, no incidences
All category data between both groups were compared using the of intraoperative hemorrhage or bile leak were documented, but
Chi-square test. Independent student t-test was used to compare Group B had two cases of bile leak and four cases of intraoperative
continuous variable data, such as operative time. A statistically cystic artery bleed. 9
significant p-value was less than 0.05. Our findings were consistent with those of Das et al., Katrina
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et al., and Anurag Chauhan et al., who investigated the use
of monopolar cautery for cystic artery management. In terms of
results postoperative mortality and complications, they observed no
The study consisted of 60 patients who were planned for difference between the two treatments.
laparoscopic cholecystectomy. The mean age of the study group In a research involving 160 patients undergoing laparoscopic
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A was 50.73 + 11.09 years and group B was 54.13 + 13.2 years. The cholecystectomy, Redwan compared harmonic scalpel to clips/
male:female sex ratio was 1:1 in group A with 15 females and 15 cautery. They determined that the harmonic scalpel is equally
males; in group B it was 1.3:1 with 17 females and 13 males (Table 1). successful as the clip/cautery technique in attaining hemobiliary
Among the 60 patients who underwent successful laparoscopic stasis with a shorter surgical time but is not cost-effective when
cholecystectomy, hospital stay in group A and group B was similar, compared to cautery in laparoscopic cholecystectomy.
i.e., 2.9 + 0.75 days and 2.93 + 0.9 days, respectively, and no In our study, both groups had similar outcomes, particularly in
statistical significance was established. Mean duration of surgery in terms of hospital stay and intraoperative complications. There was
Group B with 50.9 + −15 minutes which was lesser when compare no extra risk of intraoperative hemorrhage or bile leak when bipolar
to group A was 56.5 + −13 minutes, however, not statistically electrocautery was used instead of surgical clips. Postoperative
significant. There was no reporting of intraoperative hemorrhage problems such as clip slippage, dislodgement, ulceration, migration,
or bile leak in any of the cases in Group A. But in group B, out of 30 internalization, and necrosis of the cystic duct with the danger of
cases, 2 cases of bile leak and 4 cases of intraoperative cystic artery bile leakage were not a concern with electrocautery. Electrocautery
bleed was reported (Table 2). is a more affordable and accessible solution than surgical clips,
especially in developing nations.
Because the depth of burn with bipolar electrocautery is
dIscussIon unpredictable, simple precautions such as staying close to the gall
Mühe conducted the first laparoscopic cholecystectomy in bladder wall during dissection, avoiding diathermy near metal clips
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1986. The gold standard treatment for cholelithiasis is now on the cystic duct and control of the cystic artery, preferably lateral
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regarded laparoscopic cholecystectomy. This new procedure to the cystic lymph node, can help to prevent injury. It is critical to
World Journal of Laparoscopic Surgery, Volume 15 Issue 1 (January–April 2022) 75