Laparoscopic Cholecystectomy With Harmonic Scalpel

Abstract

This study suggests that the Harmonic scalpel is a safe and effective instrument for laparoscopic cholecystectomy, because it provides complete hemobiliary stasis.

Clipped vs Clipless Laparoscopic Cholecystectomy using the Ultrasonically Activated (Harmonic) Scalpel

“…This has many potential advantages, including reducing the overall anesthetic time and increasing the number of cases that can be done on an average operative list. Similar finding was reported by Khan et al 9 and Gelmini et al 10 In our study, neither minor nor major bile leaks were encountered in either groups, and this could be explained partially by small number of patients in each group, although similar findings were reported by Tebala 3 and Bessa et al 5 In the present study, as well as in the Westervelt, 4 Tebala, 3 and Khan et al 9 studies, the harmonic shears were applied to only one site on the cystic duct where sealing and division were achieved with no bile leaks from the cystic duct stump encountered in any of the three studies. It is our belief that a double application of the harmonic shears to the cystic duct is unnecessary and may be an unsafe practice.…”

“…Several studies have confirmed the effectiveness and safety of the use of the ultrasonically activated scalpel for dissection of the gallbladder, but only a few authors [3][4][5]7,9,10 have examined its efficacy in the closure of the cystic artery and duct. In 1999, the use of ultrasonically activated shears for both dissection and closure-division of the cystic duct and artery was first reported.…”

An evaluation of electrosurgical vessel-sealing devices in biliary tract surgery in a porcine model

“…The importance and clinical relevance of these devices for use in biliary tract surgery, specifically laparoscopic cholecystectomy, refer to the issue of whether these devices can adequately seal the cystic duct; if they can, this would allow the surgeon to use one instrument for sealing the cystic duct and cystic artery, and for dissecting the gallbladder from the liver bed, therefore making the surgeon more efficient and possibly decreasing operating room time 12 . The purpose of our study was to evaluate the use of two commonly used electrosurgical devices, an electrothermal bipolar vessel‐sealing device (EBVS) and ultrasonic coagulation shears, in biliary tract surgery.…”

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

“…Both the groups had similar operative time and blood loss (both P > .05).However the mean operative time for Harmonic scalpel group was shorter than the Monopolar electrocautery group (18,19). 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.…”