Use of Harmonic Scalpel in Single Site Laparoscopic Cholecystectomy: a Safe Alternative. Experience in 100 consecutive cases.

M Bassante, MD, D McDonald, MD, M Kadowaki, MD. East Tennessee State University.

Background
Single site cholecystectomy is a surgical technique that is rapidly becoming an accepted alternative for laparoscopic cholecystectomy. The technique used in this procedure may vary as technology and instruments continue to improve.
In this study In this study we review our experience with this technique in the setting of 100 consecutive patients to assess the safety of a harmonic scalpel as the main dissecting instrument during the procedure.

Methods
This is a review of 100 consecutive single site cholecystectomies performed by a single surgeon at a single institution using a laparoscopic harmonic scalpel as the main dissecting instrument. . Several parameters were analyzed including: age, sex, pre-operative diagnosis, ASA score, Body Mass Index (BMI), operating time, conversion to open cholecystectomy and post-operative complications.

Results
Demographics showed a group of patients in which 60% were females, average age was 50.6±16.8 years. The average BMI was 31.4±8.67. The average ASA calss was 2.3±0.65.
The operating time averaged 58.33±25.46 minutes.
As far as preoperative diagnosis, 9% had a diagnosis of acute calculous cholecystitis, 24% had a diagnosis of biliary dyskenesia, 43% had a diagnosis of chronic Cholecystitis, 24% had a diagnosis of symptomatic cholelithiasis.
There were a total of four complications; 1 patient had a urinary tract infection and prolonged ileus, 1 patient had a bile leak from the cystic stump, 1 patient had an enterotomy during trochar placement and 1 patient was readmitted for respiratory distress and pleural effusions. The patient with an enterotomy was the only one who underwent a conversion to open exploratory laparotomy.

Conclusions

None of the complications reported were directly associated to the use of harmonic scalpel to perform a single site cholecystectomy.
The harmonic scalpel is a safe instrument which can also improve efficiency in the operating room.
Further studies are needed to evaluate the cost-effectiveness of the harmonic scalpel in single site laparoscopic cholecystectomy.
 

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