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Minerva Chirurgica 2013 December;68(6):537-42


language: English

Evaluation of three instruments for laparoscopic cholecystectomy: harmonic scalpel, bipolar vessel sealer, and conventional technique

Bulus H. 1, Basar O. 2, 3, Tas A. 4, Yavuz A. 1, Akkoca M. 1, Coskun A. 5, Coban S. 3, Tuna Y. 2, Erbis H. 6, Koklu S. 7

1 Department of General Surgery Kecioren Training and Research Hospital, Ankara, Turkey; 2 Department of Gastroenterology Akdeniz University School of Medicine, Antalya, Turkey; 3 Department of Gastroenterology Dişkapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey; 4 Department of Gastroenterology Osmaniye State Hospital, Osmaniye, Turkey; 5 Department of General Surgery Yildirim Beyazit University, Faculty of Medicine, Ankara, Turkey; 6 Department of General Surgery Pamukkale University School of Medicine Denizli, Turkey; 7 Associate professor, Department of Gastroenterology, Ankara Training and Research Hospital, Ankara, Turkey


Aim: Laparoscopy is the gold standard procedure in the surgery of gall bladder. Harmonic scalpel and bipolar vessel sealer are the other instruments for laparoscopic cholecystectomy. The aim of this study is to compare the effectiveness and safety of the three instruments for laparoscopic cholecystectomy.
Methods: A total of 60 patients were included into the study. Patients were divided into three groups. In Group A, cystic duct and artery were sealed using laparoscopic clips and gall bladder was dissected from the hepatic bed using electrocautery. In Group B, cystic duct and artery were sealed using Harmonic scalpel and gall bladder was dissected from the hepatic bed using Harmonic scalpel. In Group C, cystic duct and artery were sealed using Bipolar vessel sealer and gall bladder was dissected from the hepatic bed using Bipolar vessel sealer. Groups were compared for the following parameters: duration of surgery, amount of drainage, cystic duct opening pressure and cost.
Results: The duration of surgery was 31.5±11.1 minutes in Group B, 33.1±10 minutes in Group A, and 36.5±9.9 in Group C; and the difference between Group B and Group C was statistically significant (P<0.04). Cystic duct opening pressure was highest in Group A which was 324.0±23.4 mmHg. For all of these 3 groups total cost was found to be 900$, 2900$, 1800$ for groups A, B, and C; respectively.
Conclusion: In laparoscopic cholecystectomy different energy source instruments may be safe to use with a cautious dissection and sealing of the cystic duct.

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