Methods of cystic duct occlusion during laparoscopic cholecystectomy

Abstract

We are unable to determine the benefits and harms of different methods of cystic duct occlusion because of the small sample size, short period of follow-up, and lack of reporting of important outcomes in the included trials. Adequately powered randomised trials with low risk of bias and with long periods of follow-up and assessing all of the important outcomes for patients and professionals are necessary.

Clipless laparoscopic cholecystectomy: 3 Port access.

“…Some authors have recommended that cystic duct should be safely ligated before using Harmonic to avoid bile spillage. 24 While 2/0 silk has been used by some authors to secure the cystic duct, 25 we used 2/0 vicryl extracorporeal knot followed by sealing of distal cystic duct with Harmonic scalpel with encouraging results.…”

Clipless laparoscopic cholecystectomy: 3 Port access.

“…Some authors have recommended that cystic duct should be safely ligated before using Harmonic to avoid bile spillage. 24 While 2/0 silk has been used by some authors to secure the cystic duct, 25 we used 2/0 vicryl extracorporeal knot followed by sealing of distal cystic duct with Harmonic scalpel with encouraging results.…”

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

“…Bulus et al 16 reported that the duration was 34.1 ± 10 minutes by using clips , 30.5 ± 11.1 minutes for Harmonic, and 36.5 ± 9.9 for bipolar vessel sealer. Gurusamy et al 17 showed that the operative time was statistically significant 12 minutes longer in the suture ligation group than in the clip group. Although clipping needs repeated insertion of clip applier, its operative time is much shorter than knotting as the later needs more technical skills that surgeons do not commonly practice.…”

Risk identification and technical modifications reduce the incidence of post-cholecystectomy bile leakage: analysis of 5675 laparoscopic cholecystectomies

“…Locking absorbable clips have a reduced cystic duct leak rate compared with metal clips, are not associated with artefacts on subsequent imaging and have a reduced incidence of migration [32]. Sutures, three-throw reef knots and Roeder slip knots [32,33] have also been used. However, a Cochrane review [33] on best available cystic duct occlusion did not conclude in favour of any method due to inadequate samples.…”

“…Sutures, three-throw reef knots and Roeder slip knots [32,33] have also been used. However, a Cochrane review [33] on best available cystic duct occlusion did not conclude in favour of any method due to inadequate samples.…”

Clipless laparoscopic cholecystectomy: 3 Port access.

“…Some authors have recommended that cystic duct should be safely ligated before using Harmonic to avoid bile spillage. 24 While 2/0 silk has been used by some authors to secure the cystic duct, 25 we used 2/0 vicryl extracorporeal knot followed by sealing of distal cystic duct with Harmonic scalpel with encouraging results.…”

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

“…Bulus et al 16 reported that the duration was 34.1 ± 10 minutes by using clips , 30.5 ± 11.1 minutes for Harmonic, and 36.5 ± 9.9 for bipolar vessel sealer. Gurusamy et al 17 showed that the operative time was statistically significant 12 minutes longer in the suture ligation group than in the clip group. Although clipping needs repeated insertion of clip applier, its operative time is much shorter than knotting as the later needs more technical skills that surgeons do not commonly practice.…”

Risk identification and technical modifications reduce the incidence of post-cholecystectomy bile leakage: analysis of 5675 laparoscopic cholecystectomies

“…Locking absorbable clips have a reduced cystic duct leak rate compared with metal clips, are not associated with artefacts on subsequent imaging and have a reduced incidence of migration [32]. Sutures, three-throw reef knots and Roeder slip knots [32,33] have also been used. However, a Cochrane review [33] on best available cystic duct occlusion did not conclude in favour of any method due to inadequate samples.…”

“…Sutures, three-throw reef knots and Roeder slip knots [32,33] have also been used. However, a Cochrane review [33] on best available cystic duct occlusion did not conclude in favour of any method due to inadequate samples.…”

Clipless laparoscopic cholecystectomy: 3 Port access.

“…Some authors have recommended that cystic duct should be safely ligated before using Harmonic to avoid bile spillage. 24 While 2/0 silk has been used by some authors to secure the cystic duct, 25 we used 2/0 vicryl extracorporeal knot followed by sealing of distal cystic duct with Harmonic scalpel with encouraging results.…”

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

“…Bulus et al 16 reported that the duration was 34.1 ± 10 minutes by using clips , 30.5 ± 11.1 minutes for Harmonic, and 36.5 ± 9.9 for bipolar vessel sealer. Gurusamy et al 17 showed that the operative time was statistically significant 12 minutes longer in the suture ligation group than in the clip group. Although clipping needs repeated insertion of clip applier, its operative time is much shorter than knotting as the later needs more technical skills that surgeons do not commonly practice.…”

Risk identification and technical modifications reduce the incidence of post-cholecystectomy bile leakage: analysis of 5675 laparoscopic cholecystectomies

“…Locking absorbable clips have a reduced cystic duct leak rate compared with metal clips, are not associated with artefacts on subsequent imaging and have a reduced incidence of migration [32]. Sutures, three-throw reef knots and Roeder slip knots [32,33] have also been used. However, a Cochrane review [33] on best available cystic duct occlusion did not conclude in favour of any method due to inadequate samples.…”

“…Sutures, three-throw reef knots and Roeder slip knots [32,33] have also been used. However, a Cochrane review [33] on best available cystic duct occlusion did not conclude in favour of any method due to inadequate samples.…”