Clipless Laparoscopic Cholecystectomy: Ultrasonic Dissection vs Conventional Method

Ab s t r Ac t Introduction: Laparoscopic cholecystectomy (LC) is now the gold standard treatment of gallstone disease, but with advancement in technology, there is always a scope for improvement. Ultrasonic shears has been shown to seal the duct and small-size vessel adequately but the fear of complication and sleepless nights has always hindered its use as the sole instrument for LC. Proper use of ultrasonic shears can provide improvement or refinement in LC. Materials and methods: It is a randomized controlled trial conducted at BP Koirala Institute of Health Sciences, Dharan, Nepal, from 2015 to 2016 (1 year). All the patients with symptomatic gallstone disease were assessed thoroughly and randomized into the harmonic scalpel [clipless laparoscopic cholecystectomy (CLC)] or conventional laparoscopic group (CL). Results: Over a period of 1 year, 112 patients were enrolled into CLC (53) and CL (59) groups. The demography of the patients in both the groups including age, sex, history of previous surgery, comorbid conditions, and history of acute cholecystitis was comparable. The mean operative time in our study was 38.65 ± 13.28 minutes. The operative time in the CLC group (35.91 ± 11.66 minutes vs 41.12 ± 14.23 minutes) was less though it was not statistically significant (p 0.054). However, when the “gallbladder (GB) was not perforated,” the operative time was significantly less in the CLC group (34.30 ± 9.30 minutes vs 38.70 ± 10.76 minutes, p 0.03). In our study, three (2.6%) patients required conversion to open cholecystectomy. One (1.85%) in CLC and 2 (3.2%) in the CL group (p 0.63). The visual analog score (VAS) for pain in the first 12 hours and median fall in hemoglobin was significantly less in the CLC group. In our study group, a total of seven (6.25%) patients had morbidity and there was no mortality. Conclusion: With the development of ultrasonic energy source and its ability to seal the vessel and cystic duct safely, it can be utilized during LC without the need of clips.