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ORIGINAL ARTICLE
Year : 2020  |  Volume : 39  |  Issue : 1  |  Page : 23-41

Dissection by ultrasonic energy versus monopolar electrosurgical energy in laparoscopic cholecystectomy


1 Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
2 Department of General Surgery, Faculty of Girls, Al Azhar University, Cairo, Egypt

Correspondence Address:
MD Mahmoud A Mahmoud
Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo, 659856
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1115-2613.278265

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Background Gallstones remain one of the commonest surgical problems in the developed world, and despite major therapeutic advances in recent years, there has been no progress in the prevention of gallstone development, and it may lead to serious complications that may affect patients’ quality of life. Laparoscopic cholecystectomy currently is accepted as the gold standard treatment of gallstones. The advantages of such a surgical approach have been reported by a number of authors, showing both the positive effect of this method on the postoperative quality of life of the patients and its optimal short-term and long-term results. Objective To assess the safety and efficacy of ultrasonic energy as a single alternative tool in the dissection of the gallbladder during laparoscopic cholecystectomy. Patients and methods This is a prospective study that included 60 patients with gallbladder stones who were operated upon for laparoscopic cholecystectomy over 1 year starting from August 2016 till August 2017. Approval from the Ethical Committee of Faculty of Medicine, Ain Shams University, was obtained before commencement of this study. The patients upon whom the study was based were operated on in El Demerdash Hospital and Ain Shams University Specialized Hospital. Results A total of 60 patients were included in this study. Group A included 30 patients for whom laparoscopic cholecystectomy had been done using a harmonic scalpel. Group B included 30 patient for whom laparoscopic cholecystectomy had been done using electrocautery tools (hook, grasper, and scissors) and surgical clips. For both groups, data were collected and analyzed: demographic data (sex, age, BMI, comorbidities, and previous surgeries). Conclusion The main advantages of ultrasonic dissection include the following: (a) utilization of a single instrument for both dissection of the gallbladder and dissection of the artery and dust, (b) shorter operating time, and (c) improved laparoscopic view and possibly a reduction of postoperative pain. The main disadvantage of ultrasonic dissection is instrument cost, which is particularly high if the surgical unit is equipped with reusable instruments.


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