Laparoscopic cholecystectomy with harmonic scalpel (original) (raw)
The Outcomes of the Patients Undergoing Harmonic Scalpel Laparoscopic Cholecystectomy
Cureus
Laparoscopic cholecystectomy has replaced conventional open cholecystectomy and has become the gold standard surgery for gall bladder pathologies. The harmonic scalpel is one of the instruments used to dissect and coagulate. Most surgeons accept the usage of the harmonic scalpel in laparoscopic cholecystectomy. The other standard method is electrocoagulation by electrocautery. The harmonic scalpel cholecystectomy has several advantages over other methods of laparoscopic cholecystectomy. Electrocoagulation by electrocautery produces smoke which can result in damage to lateral tissues, including the gall bladder. The clips are used along with electrocoagulation to seal cystic duct and cystic artery before dissection. There are various studies about bile leakage in the case of clip application. The harmonic scalpel uses ultrasonic energy to achieve hemostasis without bleeding, dissection, and gallbladder removal from the liver bed during laparoscopic surgery by causing coagulation of proteins. The patient outcome variables such as postoperative pain, duration of hospital stay, postoperative nausea and vomiting, surgical site infections, and other complications have not been compared in review articles. In this review, we collected the information from previously published studies and reviewed the outcomes of patients undergoing harmonic scalpel cholecystectomy. Harmonic scalpel cholecystectomy reduces the duration of hospital stay, duration of operation, intraoperative and postoperative complications, and postoperative pain. Thus the harmonic scalpel can be used instead of other instruments as it has better patient outcomes.
The Use of Harmonic Scalpel for Laparoscopic Clip less Cholecystectomy
JMS SKIMS
BACKGROUND: Laparoscopic cholecystectomy (LC) is accepted as the ‘‘gold standard’’ surgical treatment of gallstones. Although surgical clip (SC) is known to be a safe closure method for cystic duct and artery, bile leakage due to clip displacement from the cystic duct stump is a potential complication. In recent years, some energy sources have been tried for the closure of the cystic duct. After the beginning of the use of a harmonic scalpel (HS) for sealing of the cystic artery, surgeons started to investigate the role of HS for sealing the cystic duct. The aim of this study was to assess the efficacy and safety of the use of HS in performing LC. OBJECTIVE: To assess the safety and efficacy of HS, as an effective alternative to clipping, for achieving perfect haemobilliary stasis in LC. MATERIAL AND METHODS: This study was carried out on 70 patients over a period of 2 years. It included 29 males and 41 females with a mean age of 40.6±12.3 years. Most of the cases (42.9%) were opera...
Introduction: Laparoscopic cholecystectomy using clips and cautery, has been the gold standard treatment for symptomatic cholelithiasis since long. But the technique still has areas requiring refinement, including complications of clips being dislodged and electrical arcing injuries, due to the use of monopolar electrocautery. This study was undertaken to demonstrate the efficacy and safety of the Harmonic scalpel as the sole instrument to achieve complete hemobiliary stasis. Material and methods: A comparative study was conducted at GMC Rajindra Hospital Patiala including sixty patients divided into two equal groups of 30 each, which underwent laparoscopic cholecystectomy using standard clip and cautery technique or the Harmonic scalpel (HS) technique. Harmonic scalpel was used to ligate and cut both the cystic duct and artery. Comparison was made with regard to the operative time, lens cleaning, intraoperative and postoperative complications. Results: The use of Harmonic scalpel results in shorter operative time and reduces the number of times lens requires cleaning, but there is no significant difference in intraoperative and postoperative complications in both group of patients. Conclusion: Harmonic scalpel is safe and effective in providing complete hemobiliary stasis, it significantly reduces the operative duration and the number of times lens is cleaned, hence making the surgeon more comfortable.
The Professional Medical Journal, 2020
Objectives: To compare the laparoscopic cholecystectomy using harmonic scalpel with conventional laparoscopic cholecystectomy in patients of symptomatic gallstones in terms of mean operative time and mean intra-operative blood loss. Study Design: Randomized Control trial. Setting: Department of Surgical at Allied Hospital Faisalabad. Period: 6 months Oct 2017 to Mar 2018. Material & Methods: Eighty (80) patients (forty in one group) divided randomly into A (harmonic scalpel group) and B (conventional) group, done under general anesthesia. Total time of operation and blood loss during procedure was noted. Results: Our study showed that mean operative time in Harmonic group (A) was 38.07+5.28 minutes and in Conventional group (B) 63.75+7.62 minutes, (p-value = 0.0001), blood loss in Harmonic group (A) 32.93+8.86ml and 55.53+8.96ml in Conventional group (B), (p-value = 0.0001). Conclusion: It is concluded that the laparoscopic cholecystectomy using harmonic scalpel is significantly bet...
Laparoscopic Dome-down cholecystectomy with the LCS-5 Harmonic scalpel
JSLS: Journal of the …, 2005
Objective:Misidentification of ductal anatomy and electrocautery injuries are complications associated with laparoscopic cholecystectomy (LC). Dome-down LC creates a 360-degree view of the gallbladder-cystic duct junction, reducing the risk for anatomy misidentification. In addition, ultrasonic instrumentation eliminates the risk for electrocautery injuries. This study assessed the feasibility and safety of dome-down LC combined with ultrasound technology.Methods:Patients with noncancerous gallbladder disease were enrolled consecutively. Gallbladders were classified by clarity (Class I to IV) of anatomy and pathology (acute, chronic, or acalculous). The gallbladder was dissected from the gallbladder bed using a dome-down technique, and the cystic artery was coagulated and transected with the LCS-5 Harmonic scalpel (Ethicon Endo-Surgery Inc., Cincinnati, Ohio). The cystic duct was ligated with 2-polydioxanone Endoloops size 2– 0 and sharply divided, leaving one Endoloop on the cystic duct stump.Results:LC was successfully completed in 105 patients (mean age, 44 years; range, 18 to 91 years) in whom the anatomy was classified as Class I in 30 (29%) patients, Class II in 42 (38%), Class III in 25 (24%), and Class IV in 8 (8%). Gallbladder dissection time ranged from 8 to 42 minutes (mean, 18 min). The operating room time ranged from 32 to 128 minutes (mean, 55 min). Two gallbladder perforations occurred, but no complications were associated with the extrahepatic biliary tree, viscera, or major blood vessels. Elective conversion occurred in 8 (7.6%) patients due to poor visualization of anatomy because of inflammation and adhesions. Patient blood loss was minimal in all cases. No postoperative complications were observed after a 6-month follow-up.Conclusion:Dome-down laparoscopic cholecystectomy with the LCS-5 Harmonic scalpel decreases the potential for misidentification of ductal anatomy, has minimal complications, and eliminates electrocautery risks. Conversion is related to poor visualization of anatomy due to inflammation and adhesions.
Clipless Laparoscopic Cholecystectomy: Our Experience
International Journal of Contemporary Medical Research [IJCMR], 2019
Background:Laparoscopic cholecystectomy (LC) is accepted as the gold standart treatment of gallstones. Various methods have been developed to close the cystic duct (CD) and cystic artery (CA), but titanium clip application is currently the most frequently used technique. High-tech electrosurgical instruments, such as Harmonic Scalpel (HS), have been used both for dissection of the cystic artery and Cystic duct. The present study was conducted to observe and establish efficacy of clipless cholecystectomy, by use of harmonic scalpel as an alternative, for division and sealing of cystic artery and cystic duct. Methods: This study was a hospital based, retrospective study, conducted in Govt. Medical College, Srinagar, using medical records. A total of 114 patients included in the study, having been operated by a single surgeon over time period of 5 years from February 2014 to january 2019. Results: In our study of 114 patients 82 (71.92%) were females and 32 (28.07%) were males with average age of 41.4years (16-72 yr). No patient was converted to open with average operating time of 24.2 minutes (18-46 minutes). Mean hospital study was 1.42 days (1-8 days) with no mortality. Postoperative complications were found in 6 (5.2%) patients with bile leak from duct of Lushka in 1 (0.8%) patient, port site infection in 2 (1.7%) patients and fever in 3 (2.6%) patients.Gallbladder perforation intraoperatively was seen in 7 (6.2%) patients. Conclusions:Use of harmonic scalpel is an excellent option for the cystic duct closure with less time consumption and less complications.
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2017
OBJECTIVE To determine the efficacy of ultrasound shear in laparoscopic cholecystectomy in terms of total operative time, postoperative bile leaks, gall bladder perforation rate, and postoperative bleeding from cystic artery and collateral injury to bowel and duodenum. STUDY DESIGN Comparative study. PLACE AND DURATION OF STUDY Mayo Hospital, Lahore, from June 2013 to May 2014. METHODOLOGY 150 cases (75 in each group) were randomized into two groups, i.e. harmonic scalpel clipless group (HSG) versus conventional laparoscopic cholecystectomy (CLC) with electrocautery group. The above stated variables were documented. The data for age, blood loss, and drain output were positively skewed as calculated using the Shapiro-Wilk test. The histograms, Q-Q plots and box plots were analyzed for all the dependent variables. Skewed qualitative continuous data was analyzed using the Mann-Whitney U-Test. RESULTS Operative time was significantly lower in HSG as compared to CLC. Median operative tim...
Single access cholecystectomy using standard laparoscopic instruments
Updates in Surgery, 2011
The aim of this study was to verify feasibility and safety of single incision laparoscopic cholecystectomy using conventional surgical instruments. Twenty patients underwent single incision laparoscopic cholecystectomy. Indications for cholecystectomy were symptomatic cholelithiasis. Operative time, postoperative length of stay, intraoperative and postoperative complications, postoperative pain (by visual analogue scale), and patient cosmetic satisfaction were considered. All 20 procedures were successfully concluded without additional skin incisions. The mean operative time was 69 ± 16 min with a trend toward a reduction in operating time with increasing surgical experience. Intraoperative bile leakages for gallbladder rupture were observed in only three cases. No postoperative complications were recorded. The median pain scale value was 3 and the median value of cosmetic satisfaction was 3. The mean postoperative length of stay was 1.3 ± 0.9 days. Single incision laparoscopic cholecystectomy with conventional surgical instruments is a feasible and safe procedure, but additional studies in larger series are needed to confirm our results.
Techniques of laparoscopic cholecystectomy: Nomenclature and selection
Journal of minimal access surgery
There are more than 50 different techniques of laparoscopic cholecystectomy (LC) available in literature mainly due to modifications by surgeons in aim to improve postoperative outcome and cosmesis. These modifications include reduction in port size and/or number than what is used in standard LC. There is no uniform nomenclature to describe these different techniques so that it is not possible to compare the outcomes of different techniques. We brief the advantages and disadvantages of each of these techniques and suggest the situation where particular technique would be useful. We also propose a nomenclature which is easy to remember and apply, so that any future comparison will be possible between the techniques.
Khyber Medical University Journal, 2014
OBJECTIVE: to evaluate the safety of ultrasonic (harmonic) dissection during laparoscopic cholecystectomy in terms of gall bladder perforation. METHODOLOGY: This descriptive study was conducted at surgical B unit of Lady Reading Hospital, Peshawar from July 2007 to December 2008, on 120 patients with symptomatic gallstones. Patients fulfilling the study criteria, were selected on consecutive non-probability sampling technique. All the patients were operated laproscopicaly through standard four-port technique. Ultrasonic device (harmonic) was used for GB dissection off its bed. Intraoperatively bile leak or stone spillage was looked for suggesting GB perforation. The demographic and clinical (intraoperative) data of the all the patients were recorded in a proforma and data was analyzed with SPSS version-16. RESULTS: The age of the patients ranged from 18 to 70 years with the maximum number in the 4th decade. The mean age was 40.15±12.632 years. The male to female ratio was 1: 6.66. The mean hospital stay was 3.37±0.766 days. Patients with gall bladder perforation were 20 (16.7%) and 16.6% of the gall bladder perforation occurred in 21 to 50 years of age. The gall bladder perforation in male and female were 8.3% and 8.3% respectively. CONCLUSION: Ultrasonic dissection of gall bladder from its bed is a safe technique and carried 16.7% risk of all bladder perforation. In resources limited countries, proper training of laparoscopic surgery should be encouraged.