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ASGBI Oral Presentation:
Manchester 2007

Benign Hepatobiliary Section

A clipless technique for laparoscopic cholecystectomy using the harmonic scalpel

T. Vu, D. Patel, N. Marshall

Newham University Hospital, London

Background: The technique of laparoscopic cholecystectomy still has areas of refinements, including complications of clips being dislodged. The use of ultrasonically activated scalpel for tissue cutting and coagulation is a potential replacement for electrosurgery, which can be related to different complications. The harmonic scalpel has been used safely in other general surgical operations. The primary use of the Harmonic scalpel in laparoscopic cholecystectomies has been for the division of the cystic artery and liver bed dissection. Advancements in theHarmonic scalpel blade tip now provide for the reliable ultrasonic division and closure of the cystic duct.

Methods: This was a prospective study of 22 patients undergoing laparoscopic cholecystectomy in a London hospital using the harmonic scalpel. These were elective patients for gallstones disease diagnosed with Ultrasound. Harmonic scalpel was used as the sole instrument for division of the cystic duct and artery as well as dissection of the liver bed. The average age of patient was 42.5 years (range 22-61 years) with 5 male and 17 female patients.

Results: The average operation time was 34 minutes. However, this is inclusive of time from instrumental and skin preparation to closure of skin. The average post-operative inpatient stay was 7.2 hours (all discharged on the same day of surgery). No patients developed postoperative haemorrhage or bile leakage. Only one patient had a complication of a superficial wound infection which was treated with oral antibiotics.

Conclusion: The Harmonic scalpel provides complete haemobiliary stasis for all patients and is a safe alternative to standard clip or ligature closure of the cystic duct. Furthermore, there may be a cost savings inherent in a procedure utilizing a single disposable instrument as well inpatient stay and recovery period.

Presented at the Association of Surgeons of Great Britain and Ireland International Conference in Manchester on April 19th 2007

Advanced Laparoscopic Surgery Techniques by Nicholas Marshall