Laparoscopic cholecystectomy with Harmonic scalpel

Abstract

Background: Laparoscopic cholecystectomy is the "gold standard" in the treatment of symptomatic gallbladder lithiasis. Nevertheless, some pitfalls are associated with the use of the monopolar hook, such as the risk of thermal injuries and biliary complications. By contrast, the ultrasonically activated scalpel, ie, Harmonic (Ethicon Endo Surgery INC - Johnson & Johnson Medical SPA, Somerville, NJ) in laparoscopic cholecystectomies has been increasingly used for dissection of the gallbladder and for division of vessels and the cystic duct, because it reduces the risk of thermal injuries.

Methods: During a 2-year period, in a personal series of 95 consecutive patients, the Harmonic scalpel was used as the sole instrument for both division and dissection of the cystic artery and duct. The average length of inpatient stay, procedure duration, and complications were compared with the data of a homogenous control group of patients who were treated using monopolar electrosurgery and clips.

Results: Neither major complications nor bile duct injuries were detected in either group, and no statistically significant difference was found between the 2 in terms of the incidence of postoperative complications. However, the mean operative time was significantly shorter in patients treated with the Harmonic scalpel.

Conclusion: The Harmonic scalpel is not only a safe and effective instrument but also a reliable substitute for clips because it provides complete hemobiliary stasis. Even if the study revealed no differences with regard to postoperative complications, the Harmonic scalpel represents a viable alternative because of the shorter operation time and cost savings that are inherent in a procedure using it as a single instrument.