OBJECTIVE: Nowadays, laparoscopic cholecystectomy (LC) is undoubtedly considered the "gold standard" in the surgical treatment of symptomatic gallstones,gallbladder adenomas and acute cholecystitis. Among the alternative energysources proposed (monopolar, bipolar electric scalpel, radiofrequency sealers)with the aim to dissect and/or seal, the ultrasonic energy has been frequentlyadopted, however without a widespread acceptance among surgeons for routine oremergency laparoscopic cholecystectomy. This study investigates the possiblebeneficial aspects of ultrasonic dissection and its efficacy in the closure ofthe cystic artery and duct.PATIENTS AND METHODS: Patients were retrospectively divided into 2 groupsaccording to the instruments used for division of the cystic artery and duct aswell as for dissection of the liver bed: 121 patients in whom dissection andcoagulation were performed using monopolar coagulation and 43 patients who wereall treated with the ultrasonically activated scalpel harmonic ACE (EthiconEndo-Surgery) as the sole instrument used in the whole procedure.RESULTS: The mean operative time, was significantly shorter in the harmonic groupthan in the traditional group (35.36 + 10.15 min vs. 55.6+12.10 vs. respectively;p < 0.0001). The rate of gallbladder perforation was significantly higher in the traditional group than in the harmonic group 20.66% (25 patients) vs. 6.98% (3patients), respectively; p < 0.05). Intraoperative volume blood loss wassignificantly more in the traditional group than in the HS group (29.32+14.21 vs.12.41+8.22; p < 0.0001). The mean amount of postoperative drainage was notsignificantly different among the two group (18.41+6.54 vs. 15.96+8.69 ml, p >0.05). No considerable visceral injury has been recorded in either group. Thepostoperative parameters observed included postoperative hospital stay andmorbidity for each group. The hospital stay was not significantly shorter inharmonic group (48.15+4.29 vs. 49.06+2.94 h, p > 0.05). The overall morbidityrate was 14.02 % (not significant).CONCLUSIONS: The use of the harmonic scalpel shows some statistically significantadvantages limited to a few intraoperative parameters. We conclude that a wideruse of harmonic scalpel not offers such advantages to make it the referencetechnique.

Laparoscopic cholecystectomy: ultrasonic energy versus monopolar electrosurgical energy.

ZANGHI, Antonino;DI VITA, Maria Domenica;Cardì F;CAPPELLANI, Alessandro
2014

Abstract

OBJECTIVE: Nowadays, laparoscopic cholecystectomy (LC) is undoubtedly considered the "gold standard" in the surgical treatment of symptomatic gallstones,gallbladder adenomas and acute cholecystitis. Among the alternative energysources proposed (monopolar, bipolar electric scalpel, radiofrequency sealers)with the aim to dissect and/or seal, the ultrasonic energy has been frequentlyadopted, however without a widespread acceptance among surgeons for routine oremergency laparoscopic cholecystectomy. This study investigates the possiblebeneficial aspects of ultrasonic dissection and its efficacy in the closure ofthe cystic artery and duct.PATIENTS AND METHODS: Patients were retrospectively divided into 2 groupsaccording to the instruments used for division of the cystic artery and duct aswell as for dissection of the liver bed: 121 patients in whom dissection andcoagulation were performed using monopolar coagulation and 43 patients who wereall treated with the ultrasonically activated scalpel harmonic ACE (EthiconEndo-Surgery) as the sole instrument used in the whole procedure.RESULTS: The mean operative time, was significantly shorter in the harmonic groupthan in the traditional group (35.36 + 10.15 min vs. 55.6+12.10 vs. respectively;p < 0.0001). The rate of gallbladder perforation was significantly higher in the traditional group than in the harmonic group 20.66% (25 patients) vs. 6.98% (3patients), respectively; p < 0.05). Intraoperative volume blood loss wassignificantly more in the traditional group than in the HS group (29.32+14.21 vs.12.41+8.22; p < 0.0001). The mean amount of postoperative drainage was notsignificantly different among the two group (18.41+6.54 vs. 15.96+8.69 ml, p >0.05). No considerable visceral injury has been recorded in either group. Thepostoperative parameters observed included postoperative hospital stay andmorbidity for each group. The hospital stay was not significantly shorter inharmonic group (48.15+4.29 vs. 49.06+2.94 h, p > 0.05). The overall morbidityrate was 14.02 % (not significant).CONCLUSIONS: The use of the harmonic scalpel shows some statistically significantadvantages limited to a few intraoperative parameters. We conclude that a wideruse of harmonic scalpel not offers such advantages to make it the referencetechnique.
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/20.500.11769/17143
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