Clippless Laparoscopic Cholecystectomy Using Ultrasonic Dissection

Abstract Background: The surgical removal of the gallbladder, or cholecystectomy, is one of the more commonly performed procedures by general surgeons. Cholecystectomy represents the most common biliary tract procedure and the second most common surgical procedure overall. Aim of Study: To evaluate the role of Harmonic scalpel in laparoscopic cholecystectomy in closure of cystic duct and artery and its complications. Patients and Methods: This prospective randomized study was conducted at El-Zahra University Hospital, Cairo, Egypt, on 100 consecutive patients between March 2017 and October 2019 with chronic calcular cholecystitis. Patient selection for the study was based on clinical diagnosis, ultrasonographic examination findings, laboratory investigations. All patients of the study were subjected to laparoscopic cholecystectomy using the harmonic scalpel for hemostasis and for sealing of the cystic duct without using any ligatures or clips. Results: The operative time in patients of the study ranged between 40-105min with a mean operative time of 55.4±15.6 min. In our patients post-operative bleeding occur in two cases (2%) which was minimal and stopped spontaneously, wound infection in 3 patients (3%), bile leak was present in one case (1%), which stop spontaneously after 5 days. Conclusion: The use of ultrasonic technology in the closure of the cystic duct has proven to be as safe and effective as the commonly used simple metal clips. Neither minor nor major bile leaks attributed to the use of ultrasonic technology were encountered throughout the study period.