SINGLE WORKING INSTRUMENT, DOUBLE TROCARS, CLIPLESS CHOLECYSTECTOMY USING HARMONIC SCALPEL. A FEASIBLE, SAFE, AND LESS INVASIVE TECHNIQUE | ||||
| The Egyptian Journal of Surgery | ||||
| Volume 29, Issue 1, January 2010, Page 40-47 PDF (812.63 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/ejsur.2010.367579 | ||||
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| Author | ||||
| Alaa Redwan* | ||||
| General Surgery Department, Assuit University Hospitals, Faculty of Medicine, Assuit University, Egypt | ||||
| Abstract | ||||
| Aim: To evaluate safety and efficacy of harmonic scalpel in closure/division of the cystic duct and artery, and bladder dissection in laparoscopic cholecystectomy as a single working instrument, with the use of two working trocars technique, compared with clip/cautery, three trocars technique. Method: A prospective study included 160 patients with symptomatic gall stone disease were randomly assigned for laparoscopic cholecystectomy by either harmonic shear, with two trocars (Group I = 80 patients), or Group II (clip/cautery, 3 trocars) including 80 patients. Results: No significant complications were encountered in either group; however 1 case of Group II suffered mild leakage treated conservatively. Intra-operative bile spillage was insignificantly lower in Group I (10% vs. 13%; P=0.46). The median operative time was significantly shorter in Group I (20 vs. 45 minutes; P=0.0001). Also hospital stay was significantly shorter in Group I (1 vs. 1.5 days; P=0.001), but no significant difference found in the incidence of post-operative complications. The overall cosmetic results and patient satisfaction was better in Group I. Conclusion: Harmonic shear is as safe and effective as clip/cautery technique in achieving hemo-biliary stasis; with shorter operative time, especially if used solely as a working instrument. Two trocars technique is safe, feasible, and provides better cosmetic results and patient satisfaction. | ||||
| Keywords | ||||
| Ultrasonic dissectors; laparoscopic trocars; cosmesis | ||||
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