Clipless Laparoscopic Cholecystectomy by Ultrasonic

Background: Ultrasonically activated devices have been used in gallbladder dissection in laparoscopic cholecystectomy with encouraging results. The aim of this study was to compare between the safety and efficacy of the harmonic scalpel and the commonly used clip technique in achieving safe closure and division of the cystic duct in alaparoscopic cholecystectomy. Methods: In this prospective study, 114 patients with chronically inflamed symptomatic gallstone disease were randomly assigned to either a harmonic scalpel laparoscopic cholecystectomy, group (Group1=58 patients) where closure and division of the cystic duct was achieved solely by a harmonic scalpel or by clip laparoscopic cholecystectomy group (Group2=56 patients). Results: Neither minor nor major bile leaks were encountered in either group (p=0.2). Similarly, no bile-duct injuries were encountered in the present study. The incidence of gallbladder perforation was statistically insignificant ( P=0.972). The median operative time was shorter in the group 1 than in the group 2, statistically significant (23 vs. 30 minutes, respectively; P=0.000). No statistically significant difference was found in the incidence of postoperative complications between the two groups. Conclusions: The harmonic shears are as safe and effective as the commonly used clip technique in achieving safe closure and division of the cystic duct in a laparoscopic cholecystectomy. Further, it provides a superior alternative to the currently used method in terms of shorter operative.