Abstract
Abstract
Aim:
The aim of this study was to evaluate the safety and efficacy of the Harmonic scalpel (Ethicon Endo-Surgery, Cincinnati, OH) in the closure/division of the cystic duct and artery, and bladder dissection in laparoscopic cholecystectomy as a single working instrument, with the use of a two-working-trocar technique, compared with the regular laparoscopic clip/cautery, three-trocar technique.
Methods:
This prospective study included 160 patients with symptomatic gallstone disease who were randomly assigned for laparoscopic cholecystectomy by either Harmonic shear as a single working instrument, with the two-trocar technique (group 1 = 80 patients) or group 2 (regular clip/cautery, three-trocar technique) comprising 80 patients.
Results:
No significant complications were encountered in either group; however, 1 case in the regular laparoscopy group suffered mild leakage that was treated conservatively. Intraoperative bile spillage was insignificantly comparable in both groups (10 versus 13%; P = 0.46). The median operative time was statistically significantly shorter in the Harmonic group (20 versus 45 minutes; P = 0.0001). Also, hospital stay was significantly shorter in the Harmonic group (1 versus 1.5 days, respectively; P = 0.001), but no statistically significant difference was found in the incidence of postoperative complications. The overall cosmetic results and patient satisfaction was better in the Harmonic group.
Conclusions:
The Harmonic shear is as safe and effective as the clip/cautery technique in laparoscopic cholecystectomy in achieving hemobiliary stasis, with shorter operative time, especially if used solely as a working instrument. The two-trocar technique is safe, feasible, and provides better cosmetic results and patient satisfaction.
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