World Journal of Surgery

, Volume 35, Issue 1, pp 212–216 | Cite as

Closure of the Cystic Duct During Laparoscopic Cholecystectomy in Children Using the LigaSure Vessel Sealing System

  • Salmai Turial
  • Veronika Engel
  • Tamer Sultan
  • Felix Schier
Article
First Online:

Abstract

Background

The goal of the present study was to evaluate the efficacy of the LigaSure™ Vessel Sealing System (LVSS) when used for cystic duct closure during laparoscopic cholecystectomy in children and adolescents.

Methods

The laparoscopic cholecystectomy was performed beginning with visualization of Calot’s triangle, and dissection of Calot’s triangle was achieved using a monopolar cautery device. Once the cystic duct was exposed, sealing was performed proximally and distally, and the cystic duct was divided midway using the LVSS. The procedure was completed in the standard fashion.

Results

The closure of the cystic duct was performed in seven cases of simultaneous cholecystectomy and splenectomy and in 15 cases of microlaparoscopic cholecystectomy. The patients’ ages ranged from 7 to 21 years (average = 14.5 years), and body weight ranged from 42 to 83 kg (average = 58 kg). There was no bile leakage noted, and the closure of the cystic duct was sufficient in all cases. We noted one case of common bile duct obstruction on postoperative day 1. In this case, an exploration of the biliary tree was performed by laparotomy. No direct injury to the common bile duct was found during exploration, but thermal changes were detected in the surrounding tissues as a result of transmitted thermal energy caused by bipolar cautery device.

Conclusion

The closure of the cystic duct using the LVSS is feasible and effective in laparoscopic cholecystectomy in children. However, it is important to keep a safe distance from other intra-abdominal structures when using thermal energy devices to prevent thermal collateral damage.

Keywords

Common Bile Duct Laparoscopic Cholecystectomy Cystic Duct Harmonic Scalpel Biliary Leakage 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in to check access.

References

  1. 1.
    Yao HS, Wang Q, Wang WJ et al (2009) Prospective clinical trials of thyroidectomy with LigaSure vs conventional vessel ligation: a systematic review and meta-analysis. Arch Surg 144(12):1167–1174CrossRefPubMedGoogle Scholar
  2. 2.
    Cakabay B, Sevinç MM, Gömceli I et al (2009) LigaSure versus clamp-and-tie in thyroidectomy: a single-center experience. Adv Ther 26(11):1035–1041CrossRefPubMedGoogle Scholar
  3. 3.
    Nouri K, Ott J, Demmel M et al (2009) Bipolar vessel sealing increases operative safety in laparoscopic-assisted vaginal hysterectomy. Arch Gynecol Obstet [Epub ahead of print]Google Scholar
  4. 4.
    Lambert EH, Schachter LR, Altamar HO et al (2010) A sealed bladder cuff technique during laparoscopic nephroureterectomy utilizing the LigaSure electrosurgical device: laboratory and clinical experience. J Endourol 24(3):327–332CrossRefPubMedGoogle Scholar
  5. 5.
    Elemen L, Yazir Y, Tugay M et al (2010) LigaSure compared with ligatures and endoclips in experimental appendectomy: how safe is it? Pediatr Surg Int 26(5):539–545CrossRefPubMedGoogle Scholar
  6. 6.
    Hartwig W, Duckheim M, Strobel O et al (2010) LigaSure for pancreatic sealing during distal pancreatectomy. World J Surg 34(5):1066–1070CrossRefPubMedGoogle Scholar
  7. 7.
    Kovács O, Szántó Z, Krasznai G et al (2009) Comparing bipolar electrothermal device and endostapler in endoscopic lung wedge resection. Interact Cardiovasc Thorac Surg 9(1):11–14CrossRefPubMedGoogle Scholar
  8. 8.
    Cakan A, Yoldas B, Samancilar O et al (2009) LigaSure vessel sealing system versus harmonic scalpel for sutureless nonanatomical pulmonary resections in a rabbit model. Which one is safer? Eur Surg Res 43(1):24–28CrossRefPubMedGoogle Scholar
  9. 9.
    Aydogan F, Saribeyoglu K, Simsek O et al (2009) Comparison of the electrothermal vessel-sealing system versus endoclip in laparoscopic appendectomy. J Laparoendosc Adv Surg Tech A 19(3):375–378CrossRefPubMedGoogle Scholar
  10. 10.
    Sucullu I, Filiz AI, Kurt Y et al (2009) The effects of LigaSure on the laparoscopic management of acute appendicitis: “LigaSure assisted laparoscopic appendectomy”. Surg Laparosc Endosc Percutan Tech 19(4):333–335CrossRefPubMedGoogle Scholar
  11. 11.
    Nii A, Shimada M, Ikegami T et al (2008) Efficacy of vessel sealing system for major Glisson bundles and major bile ducts. J Hepatobiliary Pancreat Surg 15(5):522–527CrossRefPubMedGoogle Scholar
  12. 12.
    Shamiyeh A, Vattay P, Tulipan L et al (2004) Closure of the cystic duct during laparoscopic cholecystectomy with a new feedback-controlled bipolar sealing system in case of biliary obstruction—an experimental study in pigs. Hepatogastroenterology 51(58):931–933PubMedGoogle Scholar
  13. 13.
    Shamiyeh A, Schrenk P, Tulipan L et al (2002) A new bipolar feedback-controlled sealing system for closure of the cystic duct and artery. Surg Endosc 16(5):812–813CrossRefPubMedGoogle Scholar
  14. 14.
    Schulze S, Krisitiansen VB, Fischer Hansen B et al (2002) Sealing of cystic duct with bipolar electrocoagulation. Surg Endosc 16(2):342–344CrossRefPubMedGoogle Scholar
  15. 15.
    Matthews BD, Pratt BL, Backus CL et al (2001) Effectiveness of the ultrasonic coagulating shears, LigaSure vessel sealer, and surgical clip application in biliary surgery: a comparative analysis. Am Surg 67(9):901–906PubMedGoogle Scholar
  16. 16.
    El Nakeeb A, Askar W, El Lithy R et al (2010) Clipless laparoscopic cholecystectomy using the harmonic scalpel for cirrhotic patients: a prospective randomized study. Surg Endosc 24(10):2536–2541Google Scholar
  17. 17.
    Kandil T, El Nakeeb A, El Hefnawy E (2010) Comparative study between clipless laparoscopic cholecystectomy by harmonic scalpel versus conventional method: a prospective randomized study. J Gastrointest Surg 14(2):323–328CrossRefPubMedGoogle Scholar
  18. 18.
    Patel SD, Patel H, Ganapathi S et al (2010) Day case laparoscopic cholecystectomy carried out using the harmonic scalpel: analysis of a standard procedure. Surg Laparosc Endosc Percutan Tech 20(1):20–23CrossRefPubMedGoogle Scholar
  19. 19.
    Humes DJ, Ahmed I, Lobo DN (2010) The pedicle effect and direct coupling: delayed thermal injuries to the bile duct after laparoscopic cholecystectomy. Arch Surg 145(1):96–98CrossRefPubMedGoogle Scholar
  20. 20.
    Chong VH, Chong CF (2010) Biliary complications secondary to post-cholecystectomy clip migration: a review of 69 cases. J Gastrointest Surg 14(4):688–696CrossRefPubMedGoogle Scholar
  21. 21.
    Al-Kubati WR (2010) Bile duct injuries following laparoscopic cholecystectomy: a clinical study. Saudi J Gastroenterol 16(2):100–104CrossRefPubMedGoogle Scholar
  22. 22.
    Pons Y, Gauthier J, Ukkola-Pons E et al (2009) Comparison of LigaSure vessel sealing system, harmonic scalpel, and conventional hemostasis in total thyroidectomy. Otolaryngol Head Neck Surg 141(4):496–501CrossRefPubMedGoogle Scholar
  23. 23.
    Sutton PA, Awad S, Perkins AC et al (2010) Comparison of lateral thermal spread using monopolar and bipolar diathermy, the Harmonic Scalpel and the Ligasure. Br J Surg 97(3):428–433CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2010

Authors and Affiliations

  • Salmai Turial
    • 1
  • Veronika Engel
    • 1
  • Tamer Sultan
    • 1
  • Felix Schier
    • 1
  1. 1.Department of Pediatric SurgeryUniversity Medical Center, Johannes Gutenberg UniversityMainzGermany

Personalised recommendations