Comparison of Laparoscopic Cholecystectomy Performed using Harmonic Scalpel as the Sole Instrument or by using Standard Clip and Electrocautery Technique

Introduction: Laparoscopic cholecystectomy using clips and cautery, has been the gold standard treatment for symptomatic cholelithiasis since long. But the technique still has areas requiring refinement, including complications of clips being dislodged and electrical arcing injuries, due to the use of monopolar electrocautery. This study was undertaken to demonstrate the efficacy and safety of the Harmonic scalpel as the sole instrument to achieve complete hemobiliary stasis. Material and methods: A comparative study was conducted at GMC Rajindra Hospital Patiala including sixty patients divided into two equal groups of 30 each, which underwent laparoscopic cholecystectomy using standard clip and cautery technique or the Harmonic scalpel (HS) technique. Harmonic scalpel was used to ligate and cut both the cystic duct and artery. Comparison was made with regard to the operative time, lens cleaning, intraoperative and postoperative complications. Results: The use of Harmonic scalpel results in shorter operative time and reduces the number of times lens requires cleaning, but there is no significant difference in intraoperative and postoperative complications in both group of patients. Conclusion: Harmonic scalpel is safe and effective in providing complete hemobiliary stasis, it significantly reduces the operative duration and the number of times lens is cleaned, hence making the surgeon more comfortable.