Harmonic scalpel Vs the conventional clip and cautery technique in single port laparoscopic cholecystectomy: A randomized controlled trial.

Samer Bessa, Ms, MD, Phd. Faculty of medicine- university of Alexandria

Background: Ultrasonically activated devices have been used to achieve complete hemobiliary stasis as well as gallbladder dissection in the classic four-port laparoscopic cholecystectomy with encouraging results. The aim of this prospective study was to compare the surgical outcome of single-port laparoscopic cholecystectomy (SPLC) performed by the harmonic shears to that performed by the conventional clip & cautery technique.

Methods: Patients with symptomatic uncomplicated gallstone disease were randomly assigned to either the Harmonic scalpel SPLC group (HS-SPLC group=60 patients) or the clip & cautery SPLC group (CC-SPLC group=60 patients).

Results: The present study included 120 patients. They were 101 females (84.2%) and 19 males (17.8%) with a median age of 38 years. The use of the harmonic shears was associated with a statistically significant shorter median dissection time (43.5 vs.72.5 minutes, P=0.001) and consequently a shorter median total operative time (71 vs. 104 minutes, P=0.001). In addition, incidence of gallbladder perforation was lower in the HS-SPLC group although the difference did not reach statistical significance (15% vs. 28.3%, P=0.076). No statistically significant difference was found between both groups as regards the incidence of postoperative complications (8.3% vs. 10%, P=0.170). Port site infection was encountered in 2 patients (3.3%) in the CC-SPLC group compared to 3 patients (5%) in the HS-SPLC group (P=1.000). Neither bile leaks nor Bile duct injuries were encountered in either group. Throughout a median follow-up duration of 11 months, one patient (1.7%) in either group developed a port site hernia.

Conclusions: In SPLC, the use of the Harmonic shears provided a superior alternative to the conventional clip &cautery in terms of shorter operative time.

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