Ultrasonic versus electrocautery dissection in laparoscopic cholecystectomy

Introduction: Monopolar electrocautery (EL) is a basic, routinely used method for securing haemostasis, however its application in laparoscopic surgery is associated with numerous limitations and risk. One possible solution for these disadvantages is the application of the harmonic scalpel (HS), using high frequency ultrasound. Aim: The aim of the study was to evaluate the practical aspects of applying HS in comparison with EL dissection In laparoscopic cholecystectomy (LC), through comparison of perioperative blood loss, operative time, and rates of conversions, complications and accidental bile spillage. Materials and methods: 946 consecutive patients underwent LC because of chronic (851) and acute (95) cholecystitis. Application of HS was dependent upon its availability - EL was used only when HS was not available. During the study, HS was applied in 789 (83.4%) cases. Results: There were no significant differences either in perioperative blood loss or in conversion rate. In the HS group, we observed a lower rate of accidental perforation of the gallbladder (HS - 12.8% vs. EL - 23.6%) and shorter operative time (HS - 30.7 min vs. 35.0 min). The difference between complication rates did not reach statistical significance (HS - 6.7% vs. EL - 8.3%). Conclusions: 1. HS is safe and efficient in laparoscopic dissection of the gallbladder. 2. Application of HS shortens the operative time and decreases the rate of accidental bile spillage. 3. To evaluate all the advantages of HS over EL, especially concerning postoperative complications, randomized clinical trials on large groups of patients ore required.