Evaluation of Clipless Laparoscopic Cholecystectomy with the Aid of Extracorporeal Mishra’s Knot

Abstract

Introduction: Routinely in laparoscopic cholecystectomy, titanium clips were utilized to secure cystic duct and artery. Lately, there are lot of advances in sealing cystic duct and artery as Harmonic Scalpel, Plasma Kinetic sealer, intracorporeal and extracorporeal suturing. Although some of these methods are effective, they are expensive with low availability. Aim of the study:To evaluate the use of extracorporeal Mishra's knot in securing cystic duct and artery in laparoscopic cholecystectomy regarding operative time, cost effectiveness and post operative complications. Patients and methods:This prospective hospital-based study was conducted between October 2017 and November 2019 at Al-Jedaani hospitals, KSA. Thirty patients who underwent laparoscopic cholecystectomy were included. Cystic duct and artery were secured with extracorporeal Mishra's knot. Results:The mean operative time was 61.81 minutes ±3.31. Postoperative bile leak and superficial surgical site infection were reported in 3.3% and 6.7% respectively. The cost of used suture material was (10-14 $). Conclusion:Using extracorporeal Mishra's knot to secure cystic duct and artery is feasible, economic and safe.