Publication:

A randomized prospective study to evaluate the efficacy of ultrasonic shears (Harmonic scalpel®) and monopolar electrocautery in dissection of gall bladder from the gall bladder bed during laparoscopic cholecystectomy

Background Laparoscopic cholecystectomy is the gold-standard treatment for symptomatic gallstones. Advances in technology have made it faster and safer. Ultrasonic shears enable dissection and vessel sealing via cavitation and coaptation, though their safety and efficacy as a sole instrument require further validation.

Methods A prospective randomized controlled study was conducted in 100 patients with symptomatic gallstones, divided into two groups: laparoscopic cholecystectomy using ultrasonically activated shears or monopolar electrocautery. Operative time, gallbladder removal, blood loss, postoperative pain scores, analgesic requirement, hospital stay, and complications were compared.

Results Patients who had a laparoscopic cholecystectomy with ultrasonic shears experienced less pain and a quicker procedure (44.18±14.03 minutes versus 54.48±16.34 minutes; p<0.001) and gallbladder removal from the gallbladder bed (9.66±4.54 minutes versus 14.18±4.67 minutes; p<0.001). They had a lower risk of gallbladder perforation (4 versus 13) and a shorter hospital stay. Additionally, on the first postoperative day, fewer analgesics were needed. The study population included 85% females and 15% males, presented in demographic analysis.

Conclusions There is no risk of serious injuries or leaks while using an ultrasonically triggered scalpel during a laparoscopic cholecystectomy. In terms of quicker and safer operation, lower related morbidity, less pain, and an earlier return to home, it performs better than electrocautery.