Total clipless cholecystectomy by means of harmonic sealing

Abstract

BackgroundIn traditional laparoscopic cholecistectomy, the cystic duct and artery are commonly closed by metallic clips just before their division. Although the placement of these clips for occluding cystic artery and duct can be considered safe, biliary leaks and bleeding may occur especially by its dislodgement.AimTo report a prospective case-series in total clipless cholecystectomy by means of harmonic shears for closure and division of the artery and cystic duct as well removal of the gallbladder from the liver.MethodsWas evaluate a series of 125 patients who underwent laparoscopic cholecystectomy where the sealing and division of cystic artery and duct was carried out only by harmonic shears. The intact extracted gallbladder was submitted to a reverse pressure test for assessment of the technique safety by means of CO2 insuflation.ResultsThe most common indication for surgery was gallstones. The mean operative time was 26 min and all gallbladders were dissected intact from the liver bed. There was no mortality and the overall morbidity rate was 0.8% with no hemorrhage or leaks. The reverse pressure test showed that all specimens support at least 36-mmHg of pressure without leaking.ConclusionsThe harmonic shears is effective and safe in laparoscopic cholecystectomy as a sole instrument for sealing and division of the artery and cystic duct. The main advantages could be related to the safety and decreased operative time.

Clipless Laparoscopic Cholecystectomy: Our Experience

“…Most of our patients were females (71.92%) which were similar to other studies like Saha et al 19 Harmonic scalpel reduces the duration of dissection, with little amount of mist, owing to no wastage of time in smoke evacuation and in changing of instruments. In our study the mean operative time was 24.2 minutes which was comparable to the study done by Jahangir Sarwar Khan et al 20 and Ramos et al 21 There was no bile leak from the cystic duct in our study, there was a single bile leak (0.8%) from duct of lushka which is in accordance with the other studies like Huscher et al 2 , Gelmini et al 22 , Bessa et al 23 , El nakeeb et al 24 In our case the patient was managed conservatively by ERCP and with sphinterotomy. In our study port site infection was found in 2 (1.7%) patients who were managed conservatively by daily dressings and antibiotics and postoperative fever in 3 (2.6%) patients managed conservatively.…”

Technical Aspects of Laparoscopic Sleeve Gastrectomy

“…Laparoscopic release of the greater curvature of the gastric fundus is faster and more secure with the use of ultrasonic energy or bipolar electrocautery. In this study, the preference is for the use of ultrasound (Ultracision Harmonic Ace Plus- Ethicon - Johnson & Johnson Corporation - USA) which by means of mechanical vibration energy enables the sealing of tissue by protein denaturation resulting in rapid and reliable hemostasis 5 , 6 , 11 .…”

Systematic review of cystic duct closure techniques in relation to prevention of bile duct leakage after laparoscopic cholecystectomy

“…Non comparative analysis consisted of data from one single arm of a randomized trial (25), sixteen retrospective studies[ 28 - 43 ] and 7 studies with a prospective design[ 44 - 50 ]. A single arm of an RCT and 5 other studies reported on harmonic energy[ 27 - 29 , 44 - 47 ].…”

“…Non comparative analysis consisted of data from one single arm of a randomized trial (25), sixteen retrospective studies[ 28 - 43 ] and 7 studies with a prospective design[ 44 - 50 ]. A single arm of an RCT and 5 other studies reported on harmonic energy[ 27 - 29 , 44 - 47 ]. Closure with ligatures was described in six articles[ 36 - 38 , 48 - 50 ] and the use of metal clips in nine[ 30 - 33 , 35 , 40 - 43 ].…”