GUSTAVO L CARVALHO, MD PhD, FLÁVIO A JÚNIOR, MD, JOSÉ S SILVA, STUDENT, CAMILA R CRUZ, STUDENT, DIEGO L LIMA, STUDENT, EDUARDO F CHAVES, STUDENT, REBECA G ROCHA, STUDENT, ADRIANO C SALES, STUDENT. UNIPECLIN, Faculty of Medical Sciences, University of Pernambuco; Recife; Brazil
INTRODUCTION: Laparoscopic cholecystectomy is nowadays one of the most frequent procedures in the world. There are several accepted techniques for sealing and cutting the cystic artery, including the use of surgical knots, endoclips, harmonic scalpel and electrocautery. Although the latter approach is faster and less expensive, many surgeons will not use this method as they consider it unsafe. Our objective is to demonstrate that the cauterization of the cystic artery in minilaparoscopic (needlescopic) cholecystectomy is a fast, safe and cost-effective alternative.
METHOD: from January 2000 to August 2010, 1219 consecutive patients undergoing minilaparoscopic (needlescopic) cholecystectomy were analyzed (76.7% women, mean age 46.4 years). All patients had chronic calculous cholecystitis in various stages of the disease or gallbladder polyps. Basic principles for safe electrocauterization were proposed: 1-Use only electronically controlled cautery with monitored return; 2-Use bipolar or blend monopolar energy (30w cut – 40w coagulation, or lower) 3-Use electrocautery in short pulses of no more than 1 second; 4-Do not use any metal clip prior to the use of cautery to avoid spreading energy near the clips, 5-Cauterize the artery always at a distance of more than 2cm of noble structures of the hepatic pedicle; 6-Use dissective grasping forceps for arteries larger than 2mm in diameters. According to the above principles, the cystic artery was cauterized safely next to the gallbladder neck and cystic duct was legated by surgical knots in all cases.
RESULTS: The mean operative time was 42 min. The mean hospital stay was 15h. There was no conversion to open surgery. In 3.1% of the patients it was necessary to convert to conventional laparoscopic cholecystectomy (5 mm). The infection rate of the umbilical incision was 1.8%, and umbilical hernia was found in 0.8%. There was no mortality, no intestinal damage, no bleeding and no damage to the main bile ducts, there was one laparoscopic reoperation for suturing a Luschka duct.
CONCLUSION: Although the safety of the electrocautery use for cystic artery section is questioned, by fear of being insufficient to seal the artery, take much time or cause tissue lesion to the pedicle structures, it does not correspond to our experience. The use of expensive instruments to section or the necessity of more time is unjustified. This study demonstrates that the use of the electrocautery for the occlusion of the cystic artery is a safe, quick and cost-efficient technique. It has been the first choice to patients who underwent needlescopic cholecystectomy.
Program Number: P379