Surgical Endoscopy

, Volume 24, Issue 3, pp 624–630

Improved outcome after laparoscopic cholecystectomy with ultrasonic dissection: a randomized multicenter trial

  • Yucel Cengiz
  • Jan Dalenbäck
  • Gunnar Edlund
  • Leif A. Israelsson
  • Arthur Jänes
  • Mats Möller
  • Anders Thorell



In conventional laparoscopic cholecystectomy, dissection with electrocautery starts at the triangle of Calot. In a randomized single-center trial, the fundus-first method (dome down) using ultrasonic dissection was faster, involved less pain or nausea, and had a shorter postoperative sick leave. This may relate to the fundus-first method or to the ultrasonic dissection.


In a multicenter trial, 243 elective patients were randomized to conventional laparoscopic cholecystectomy using electrocautery (n = 85) or the fundus-first method using either electrocautery (n = 81) or ultrasonic dissection (n = 77).


The fundus-first method had a shorter operating time with ultrasonic dissection (58 min) than with electrocautery (74 min; p = 0.002). The fundus-first method using ultrasonic dissection compared with electrocautery or the conventional method produced less blood loss (12 vs. 53 or 36 ml; p < 0.001) and fewer gallbladder perforations (26% vs. 46% or 49%; p = 0.005). Also, the pain and nausea scores at 4 and 6 h were lower, and the sick leave was shorter (6.1 vs. 9.4 and 9 days, respectively; p < 0.001).


The fundus-first method using ultrasonic dissection is associated with less blood loss, fewer gallbladder perforations, less pain and nausea, and shorter sick leave than the conventional and fundus-first method using electrocautery. The difference seems related to the use of ultrasonic dissection.


Complications Dome down Electrocautery Fundus-first Laparoscopic cholecystectomy Nausea Postoperative pain Ultrasonic dissection 


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Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Yucel Cengiz
    • 1
  • Jan Dalenbäck
    • 2
  • Gunnar Edlund
    • 3
  • Leif A. Israelsson
    • 4
  • Arthur Jänes
    • 1
  • Mats Möller
    • 5
    • 6
  • Anders Thorell
    • 5
    • 6
  1. 1.Department of SurgerySundsvall HospitalSundsvallSweden
  2. 2.Department of SurgeryFrölunda Specialist HospitalFrolundaSweden
  3. 3.Department of SurgeryÖstersund HospitalOstersundSweden
  4. 4.Department of Surgery and Perioperative ScienceUmeå UniversityUmeåSweden
  5. 5.Department of Surgery, Ersta HospitalKarolinska InstitutetStockholmSweden
  6. 6.Department of Clinical Sciences, Danderyd HospitalKarolinska InstitutetStockholmSweden

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