Skip to main content
SpringerLink
Log in

Comparative Study between Clipless Laparoscopic Cholecystectomy by Harmonic Scalpel Versus Conventional Method: A Prospective Randomized Study

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

This study was planned to compare the traditional method of laparoscopic cholecystectomy (LC) versus LC using harmonic as regard the safety and efficacy.

Material and methods

This study included group A (70 patients) in whom LC was conducted using the traditional method (TM) by clipping both cystic duct and artery and dissection of gallbladder from liver bed by diathermy, and group B (70 patients) LC was conducted using harmonic scalpel (HS) closure and division of both cystic duct and artery and dissection of gallbladder from liver bed by HS. The intraoperative and postoperative parameters were collected including duration of operation, postoperative pain, and complications.

Results

HS provides a shorter operative duration than TM (33.21 + 9.6 vs. 51.7 + 13.79, respectively, p = 0.001), with a significant less incidence of gallbladder peroration (7.1% vs. 18.6, p = 0.04) and less rate of conversion to open cholecystectomy but not reach a statistical significance. The amount of postoperative drainage is significantly less in HS (29 + 30 vs. 47.7 + 31, p = 0.001). No postoperative bile leak was encountered in HS, but it occurred in 2.9% of patients in TM. VAS in HS at 12 h postoperative was 3.25 + 1.84 vs 5.01 + 1.2 (p = 0.001) and at 24 h postoperative was 3.12 + 1.64 vs. 4.48 + 1.89 (p = 0.001).

Conclusion

HS provides a complete hemobiliary stasis and is a safe alternative to stander clip of cystic duct and artery. It provides a shorter operative duration, less incidence of gallbladder perforation, less postoperative pain, and less rate of conversion to open cholecystectomy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Fullarton GM, Bell G. A prospective audit of the introduction of laparoscopic cholecystectomy in west of Scotland. west of Scotland laparoscopic cholecystectomy audit group. Gut 1994;35(8):1121–1126.

    Article  CAS  PubMed  Google Scholar 

  2. Uchiyama K, Onishi H, Tani M, Kinoshita H, Ueno MYmanue H. Timing of laparoscopic cholecystectomy for acute cholecystitis with cholecysteolithiasis. Hepatogastroenterology 2004;51:346–348.

    PubMed  Google Scholar 

  3. Toyama Y, Milyake R, Son K, Yoshida S, Usuba T. Three port laproscopic paritial hepatectomy using an ultrasonically activated devices (USAD). J Hepatobiliary Pancreat Surg 2006;13:317–322.

    Article  PubMed  Google Scholar 

  4. Cunniffe MG, Mc Anena OJ, Dar MA, Calleary J, Flynn N. A prospective randomized trial of intraoperative bupivacaine irrigation for management of shoulder tip pain following laparoscopy. Am J Surg 1998;176:258–261.

    Article  CAS  PubMed  Google Scholar 

  5. Hardacre JM, Tallmini MA. Pulmonary and haemodynaemic changes during laparoscopy—are they important? Surgery 2000;17:241–244.

    Article  Google Scholar 

  6. Wills VL, Hunt DR. Pain after laparoscopic cholecystectomy. Br J Surg 2000;87:273–284.

    Article  CAS  PubMed  Google Scholar 

  7. Rohatgi A, Widdison A. An audit of cystic duct closure in laparoscopic cholecystectomies. Surg Endosc 2006;20:875–877.

    Article  CAS  PubMed  Google Scholar 

  8. Yano H, Okada K, Kinuta M, Nakano Y, Tono T, Matsui S, Iwazawa T, Kanoh T, Monden T. Efficacy of absorbable clips compared with metal clips for cystic duct ligation in laparoscopic cholecystectomy. Surg Today 2003;33:18–23.

    Article  PubMed  Google Scholar 

  9. Nathanson LK, Easter DW, Cuschieri A. Ligation of the structures of the cystic pedicle during laparoscopic cholecystectomy. Am J Surg 1991;161:350–354.

    Article  CAS  PubMed  Google Scholar 

  10. Tang B, Hanna GB, Joice P, Cuschieri A. Identification and categorization of technical errors by Observational Clinical Human Reliability Assessment (OCHRA) during laparoscopic cholecystectomy. Arch Surg 2004;139:1215–1220.

    Article  CAS  PubMed  Google Scholar 

  11. Tucker RD. Laparoscopic electrosurgical injuries: survey results and their implications. Surg Laparosc Endosc 1995;5(4):311–317.

    CAS  PubMed  Google Scholar 

  12. Edelman DS, Unger SW. Bipolar versus monopolar cautery scissors for laparoscopic cholecystectomy: a randomized, prospective study. Surg Laparosc Endosc 1995;5(6):459–462.

    CAS  PubMed  Google Scholar 

  13. Nduka CC, Super PA, Monson JR, Darzi AW. Cause and prevention of electrosurgical injuries in laparoscopy. J Am Coll Surg 1994;179:161–170.

    CAS  PubMed  Google Scholar 

  14. Janssen IMC, Swank DJ, Boonstra O, Knipscheer BC, Klinkenbijil JH, Goor HV. Randomized, clinical trial of ultrasonic versus electrocautery dissection of the gallbladder in laparoscopic cholecystectomy. Br J Surg 2003;90:799–803.

    Article  CAS  PubMed  Google Scholar 

  15. Wetter LA, Payne JH, Kirshenbaum G, Podoll EF, Bachinsky T, Way LW. The ultrasonic dissector facilitates laparoscopic cholecystectomy. Arch Surg. 1992;127:1195–1199.

    CAS  PubMed  Google Scholar 

  16. Tebala GD. Three-port laparoscopic cholecystectomy by harmonic dissection without cystic duct and artery clipping. Am J Surg 2006;9:718–720.

    Article  Google Scholar 

  17. Sietses C, Eijsbouts QAJ, Blomberg BME, Cuesta MA. Ultrasonic energy versus monopolar electrosurgery in laparoscopic cholecystectomy. Surg Endosc 2001;15:69–71.

    Article  CAS  PubMed  Google Scholar 

  18. Huskisson EC. Measurement of pain. Lancet 1974:1127–1131.

  19. Westervalt J. Clipless cholecystectomy: broadening the role of the harmonic scalpel. JSLS 2004;8:283–285.

    Google Scholar 

  20. Amaral JF, Chrosteek CA. Experimental comparison of the ultrasonically activated scalpel to electrosurgery and laser surgery for laparoscopic use. Min Invasive Ther Allied Technol 1997;6:324–331.

    Article  Google Scholar 

  21. Gossot D, Buess G, Cuschieri A, Leporte E, Lirici M, Marvik R, Meijer D, Melzer A, Schurr MO. Ultrasonic dissection for endoscopic surgery. Surg Endosc 1999;13:412–417.

    Article  CAS  PubMed  Google Scholar 

  22. Huscher CGS, Lirici MM, Di Paola M, Crafa F, Napolitano C, Mereu A, Recher A, Corradi A, Amini M. laparoscopic cholecystectomy by ultrasonic dissection without cystic duct and artery ligature. Surg Endosc 2003;17:442–451.

    Article  CAS  PubMed  Google Scholar 

  23. Miroshnik M, Saafan A, Koh S, Farlow J, Neophyton J, Lizzio, Yee F, Ethell T, Bean A, Fenton-Lee D. Biliary tract injury in laparoscopic cholecystectomy: results of a single unit. ANZ J Surg 2002;72:867–870.

    Article  PubMed  Google Scholar 

  24. Wise US, Glick GL, Landeros M. Cystic duct leak after laparoscopic cholecystectomy: a multiinstitutional study. Surg Endosc 1996;10:1189–1193.

    Article  Google Scholar 

  25. Hanazaki K, Igarashi J, Sodeyama H, Matsuda Y. Bile leakage resulting from clip displacement of the cystic duct stump: a potential pitfall of laparoscopic cholecystectomy. Surg Endosc 1999;13:168–171.

    Article  CAS  PubMed  Google Scholar 

  26. Nelson TM, Nakashima M, Mulvihill SJ. How secure are laparoscopically placed clips? Arch Surg 1992;127:718–720.

    CAS  PubMed  Google Scholar 

  27. McMahon AJ, Fullarton G, Baxter JN, O’Dwyer PJ. Bile duct injury and bile leakage in laparoscopic cholecystectomy. Br J Surg 1995;82:307–313.

    Article  CAS  PubMed  Google Scholar 

  28. Reis LD. Surgical clips incorporated into a duodenal ulcer: a rare complication after elective laparoscopic cholecystectomy. Endoscopy 2000;32:S3.

    Article  CAS  PubMed  Google Scholar 

  29. Labuski MR, Wise SW. Recurrent abdominal abscess secondary to a dropped laparoscopic clip: CT imaging. Abdom Imaging 1999;24:191–192.

    Article  CAS  PubMed  Google Scholar 

  30. Jorgensen J, Gillies RB, Hunt DR, Caplehorn JR, Lumely T. A simple and effective way to reduce postoperative pain after laparoscopic cholecystectomy. Aust NZJ 1995;65:466–469.

    Article  CAS  Google Scholar 

  31. Libermann MA, Howe S, Lane M. Ondansetron versus placebo for prophylaxis of nausea and vomiting in patients undergoing ambulatory laparoscopic cholecystectomy. Am J Surg 2000;179:60–62.

    Article  Google Scholar 

  32. Fredman B, Jedeikin R, Olsfanger D, Flor P, Gruzman A. Residual pneumoperitoneum: a cause of postoperative pain after laparoscopic cholecystectomy. Anesth Analg 1994;79:152–154.

    CAS  PubMed  Google Scholar 

  33. Sharma RR, Axelsson H, Oberg A, Jansson E, Clergue F. Diaphragmatic activity after laparoscopic cholecystectomy. Anesthesiology 1999;91:406–413.

    Article  CAS  PubMed  Google Scholar 

  34. Windberge UB, Auer R, Keplinnger F, Langle F, Heinze G, Losert UM. The role of intraabdominal pressure on splanchnic and pulmonary haemodynaemic and metabolic changes during CO2 pneumoperitoneum. Gastrointest Endosc 1999;49:84–91.

    Article  Google Scholar 

  35. Wallace DH, Serpell MG, Baxter JN, O’Dwyer PJ. Randomized trial of different insufflations pressure for laparoscopic cholecystectomy. Br J Surg 1997;84:455–458.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Gastroenterology Surgical Center, Faculty of Medicine, Mansoura University, Jihan St., Mansoura, Egypt

    Tharwat Kandil

  2. Mansoura University General Hospital, Surgical Departement 8, Faculty of Medicine, Mansoura University, Jihan St., Mansoura, Egypt

    Ayman El Nakeeb

  3. Department of Anasthesia, Mansoura University, Mansoura, Egypt

    Emad El Hefnawy

Authors
  1. Tharwat Kandil
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ayman El Nakeeb
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Emad El Hefnawy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tharwat Kandil.

Additional information

Tharwat Kandil, Ayman M El Nakeeb, and Emad El Hefnawy wrote the paper. Tharwat Kandil, Ayman M El Nakeeb, and Emad El Hefnawy designed research. Tharwat Kandil, Ayman M El Nakeeb, and Emad El Hefnawy performed research. Tharwat Kandil, Ayman M El Nakeeb, and Emad El Hefnawy analyzed data.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kandil, T., El Nakeeb, A. & El Hefnawy, E. Comparative Study between Clipless Laparoscopic Cholecystectomy by Harmonic Scalpel Versus Conventional Method: A Prospective Randomized Study. J Gastrointest Surg 14, 323–328 (2010). https://doi.org/10.1007/s11605-009-1039-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-009-1039-8

Keywords

Search

Navigation