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
Article

Abstract

Background

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.

Methods

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).

Results

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).

Conclusion

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.

Keywords

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

References

  1. 1.
    Gallstones and laparoscopic cholecystectomy. NIH Consens Statement 10:1–20 (1992)Google Scholar
  2. 2.
    Lau H, Brooks DC (2002) Contemporary outcomes of ambulatory laparoscopic cholecystectomy in a major teaching hospital. World J Surg 26(9):1117–1121CrossRefPubMedGoogle Scholar
  3. 3.
    Leeder PC, Matthews T, Krzeminska K, Dehn TC (2004) Routine day-case laparoscopic cholecystectomy. Br J Surg 91:312–316CrossRefPubMedGoogle Scholar
  4. 4.
    Perissat J (1993) Laparoscopic cholecystectomy: the European experience. Am J Surg 165:444–449CrossRefPubMedGoogle Scholar
  5. 5.
    Scott T, Zucker K, Bailey R (1992) Laparoscopic cholecystectomy: a review of 12,397 patients. Surg Laparosc Endosc 2:191–198PubMedGoogle Scholar
  6. 6.
    Keulemans Y, Eshuis J, de Haes H, de Wit LT, Gouma DJ (1998) Laparoscopic cholecystectomy: day-care versus clinical observation. Ann Surg 228:734–740CrossRefPubMedGoogle Scholar
  7. 7.
    Hollington P, Toogood G, Padbury R (1999) A prospective randomized trial of day-stay only versus overnight-stay laparoscopic cholecystectomy. Aust N Z J Surg 69:841–843CrossRefPubMedGoogle Scholar
  8. 8.
    Johansson M, Thune A, Nelvin L, Lundell L (2006) Randomized clinical trial of day-care versus overnight-stay laparoscopic cholecystectomy. Br J Surg 93:40–46CrossRefPubMedGoogle Scholar
  9. 9.
    Strasberg SM, Eagon CJ, Drebin JA (2000) The “hidden cystic duct” syndrome and the infundibular technique of laparoscopic cholecystectomy: the danger of the false infundibulum. J Am Coll Surg 191:661–667CrossRefPubMedGoogle Scholar
  10. 10.
    Gossot D, Buess G, Cuschieri A, Leporte E, Lirici M, Marvik R, Meijer D, Melzer A, Schurr MO (1999) Ultrasonic dissection for endoscopic surgery. The E.A.E.S. Technology Group. Surg Endosc 13:412–417CrossRefPubMedGoogle Scholar
  11. 11.
    Rosenberg J, Leinskold T (2004) Dome down laparosonic cholecystectomy. Scand J Surg 93:48–51PubMedGoogle Scholar
  12. 12.
    Janssen IM, Swank DJ, Boonstra O, Knipscheer BC, Klinkenbijl JH, van Goor H (2003) Randomized clinical trial of ultrasonic versus electrocautery dissection of the gallbladder in laparoscopic cholecystectomy. Br J Surg 90:799–803CrossRefPubMedGoogle Scholar
  13. 13.
    Amaral JF (1995) Laparoscopic cholecystectomy in 200 consecutive patients using an ultrasonically activated scalpel. Surg Laparosc Endosc 5:255–262PubMedGoogle Scholar
  14. 14.
    Power C, Maguire D, McAnena OJ, Calleary J (2000) Use of the ultrasonic dissecting scalpel in laparoscopic cholecystectomy. Surg Endosc 14:1070–1073CrossRefPubMedGoogle Scholar
  15. 15.
    Wetter LA, Payne JH, Kirshenbaum G, Podoll EF, Bachinsky T, Way LW (1992) The ultrasonic dissector facilitates laparoscopic cholecystectomy. Arch Surg 127:1195–1198 (discussion 1198–1199)PubMedGoogle Scholar
  16. 16.
    Carlander J, Johansson K, Lindström S, Velin AK, Jiang CH, Nordborg C (2005) Comparison of experimental nerve injury caused by ultrasonically activated scalpel and electrosurgery. Br J Surg 92:772–777CrossRefPubMedGoogle Scholar
  17. 17.
    Cengiz Y, Jänes A, Grehn Å, Israelsson L (2005) Randomized clinical trial of traditional dissection with electrocautery versus ultrasonic fundus-first dissection in laparoscopic cholecystectomy. Br J Surg 92:810–813CrossRefPubMedGoogle Scholar
  18. 18.
    Tsimoyiannis EC, Jabarin M, Glantzounis G, Lekkas ET, Siakas P, Stefanaki-Nikou S (1998) Laparoscopic cholecystectomy using ultrasonically activated coagulating shears. Surg Laparosc Endosc 8:421–424CrossRefPubMedGoogle Scholar
  19. 19.
    Bessa SS, Al-Fayoumi TA, Katri KM, Awad AT (2008) Clipless laparoscopic cholecystectomy by ultrasonic dissection. J Laparoendosc Adv Surg Tech A 18:593–598CrossRefPubMedGoogle Scholar
  20. 20.
    Hulley S, Cummings S, Browner W, Grady D, Newman TB (2007) Alternative trial designs and implementation issues. Designing Clinic Research, Philadelphia, pp 163–182Google Scholar

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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