Publication:

Harmonic scalpel, the tool for new age laparoscopic cholecystectomy

Background Among the various abdominal procedures, operations performed on the biliary tract are the most common and cholecystectomy is the commonest performed surgical procedure amongst them. Currently laparoscopic cholecystectomy (LC) is considered the gold standard treatment for symptomatic gallstone disease. Cholecystectomy done by harmonic scalpel is an attractive alternative technique being more cost effective and having equivalent results in regard to post-operative recovery and pain as compared to standard laparoscopic procedure. The objective of this study was to compare Clipless (Harmonic scalpel assisted) and Conventional Laparoscopic Cholecystectomy.

Methods Patients with a diagnosis of symptomatic cholelithiasis were included in the present study. Patients were divided randomly into two groups. The control group (Group-A) underwent conventional LC using mono-polar electro-surgery for dissection of gallbladder bed and clips for ligation of cystic duct and artery while the study group (Group-B) underwent LC using the harmonic scalpel. The harmonic scalpel was used as the sole instrument for division of the cystic duct and artery as well as dissection of the gallbladder bed.

Results The mean duration of surgery in the conventional LC group was found to be 46 min 50 sec and 33 min 10 sec in the clipless LC group, the difference being statistically significant (p <0.05). Perforation of gall bladder occurred in 12 cases in conventional LC group as compared to 2 cases in clipless laparoscopic (P <0.05).

Conclusions The clipless LC approach has a definite edge over conventional LC, in regard to lesser duration of surgery, fewer operative complications and shorter post-operative hospital stay.