Laparoscopic Cholecystectomy with the Use of Harmonic Scalpel
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- Category: Vol. 80, September 2012
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Laparoscopic Cholecystectomy with the Use of Harmonic Scalpel,SALAH FATHI and MOAWAD S. ABD EL-HAFEZ
Abstract
Introduction: The ultrasonically activated (Harmonic) scalpel has proven to be an effective, efficient, and safe instrument for dissection and hemostasis in both open and laparoscopic surgical procedures. This Harmonic scalpel work on the tissue’s cutting and coagulating very effectively with the replacement of the high frequency current, which can be connected with diverse complications. The principle is trans-forming of the electric power into mechanical longitudinal movement of the working part of the instrument, by piezo-electrical transducer situated in the hand piece. 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 the Harmonic scalpel blade tip now provide for the reliable ultrasonic division and closure of the cystic duct.
Methods: This was a prospective study of 40 patients undergoing laparoscopic cholecystectomy in Matarya Teaching 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 patients was 42.5 years (range 22- 61 years) with 8 male and 32 female patients. The average length of inpatient stay, procedure duration, and complications were compared with the data of a homogenous control group of patients who were treated using monopolar electrosurgery and clips.
Results: Neither major complications nor bile duct injuries were detected in either group, and no statistically significant difference was found between the 2 groups in terms of the incidence of postoperative complications. However, the mean operative time was significantly shorter in patients treated with the Harmonic scalpel.
Conclusion: The Harmonic scalpel is not only a safe and effective instrument but also a reliable substitute for clips because it provides complete hemo-biliary stasis. Even if the study revealed no differences with regard to postoperative complications, the Harmonic scalpel represents a viable alternative because of the shorter operation time and cost savings that are inherent in a procedure using it as a single instrument.