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

Abstract

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.

Clipless Laparoscopic Cholecystectomy: An initial experience of 50 cases in Bangladesh

“…Besides the common use of clips, various other techniques of securing cystic duct and arteries have been introduced. Harmonic scalpel and "LigaSure" in LC has come up recently (Kandil et al, 2010;Huscher et al, 2009). Cost of equipment is the main prohibitory factor in developing country like Bangladesh.…”

Control of cystic artery during laparoscopic cholecystectomy: clips versus ultrasonic energy devices which is better?

“…[15][16][17] any event of inappropriate control of cystic artery was documented soon after the procedure and amount of blood loss was also measured and noted.…”

Potential application of Harmonic Scalpel in Laparoscopic Cholecystectomy as an alternative to Monopolar electrocautery

“…According to a retrospective case series by Gelmini et al, 12 the use of the Harmonic scalpel in LC is associated with a significantly shorter median operative time, as compared to that of conventional monopolar electrocautery coagulation: 60 min (range, 20-205 min) vs 85 min (45-150 min); P < .001. Zanghi et al 13 also reported in a retrospective study of 164 patients that the use of the Harmonic scalpel is associated with a significantly shorter mean operative time (35 ± 10 vs 56 ± 12 min, P < .001); and Kandil et al 14 reported in a prospective, randomized study that the use of the Harmonic scalpel alone for dissection and sealing in LC resulted in almost half the mean operative time (33.2 ± 9.6 vs. 51.7 ± 13.8 min, P = .001).The reduction in operative time with HS is due to decease smoke production during dissection as well as better homeostasis.…”

“…In previous studies reporting the use of the Harmonic scalpel with less postoperative pain, the major cause may be a significantly shorter operative time for LC with a Harmonic scalpel than with Monopolar electrocautery. 14 …”