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.
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Acknowledgments
We thank Professor emeritus Willem van der Linden, Östersund, Sweden, for valuable and constructive criticism. Financial support was given by the Swedish Research Council (no. 09101), the Karolinska Institutet, the Karolinska University Hospital and Stockholm County Council (A.T.), the Torsten and Ragnar Söderberg Foundation, Sweden, the Magnus Bergvall Foundation, the Research and Development Unit, the Jämtland County Council, and the Siblings Persson Foundation (G.E.). There was no financial support or any other commercial relationship toward manufacturers of the dissectors used in the trial.
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Cengiz, Y., Dalenbäck, J., Edlund, G. et al. Improved outcome after laparoscopic cholecystectomy with ultrasonic dissection: a randomized multicenter trial. Surg Endosc 24, 624–630 (2010). https://doi.org/10.1007/s00464-009-0649-2
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DOI: https://doi.org/10.1007/s00464-009-0649-2