Volume : 6, Issue : 4, April - 2017

COMPARATIVE STUDY OF USE OF MONOPOLAR ELECTROCAUTERY VERSUS HARMONIC SCALPEL IN LAPAROSCOPIC CHOLECYSTECTOMY

T Durganna, Shylesh M P, Sujith

Abstract :

<p>&nbsp;<b><span style="font-size:14.0pt;line-height:115%;font-family:&quot;Times New Roman&quot;,serif">Background-</span></b><span style="font-size: 14pt; line-height: 115%; font-family: &quot;Times New Roman&quot;, serif;">Harmonic scalpel (HS) has been suggested as an alternative to monopolar electrocautery (EC) in laparoscopic cholecystectomy because it inflicts less tissue damage and may have a lower incidence of gallbladder perforation.</span></p> <p class="MsoNormal" style="margin-bottom:12.0pt;line-height:115%;mso-pagination:&#10;none;mso-layout-grid-align:none;text-autospace:none"><b><span style="font-size:14.0pt;line-height:115%;font-family:&quot;Times New Roman&quot;,serif">Aims and objectives-
</span></b><span style="font-size:14.0pt;line-height:115%;&#10;font-family:&quot;Times New Roman&quot;,serif"> To compare the use of EC and HS in laparoscopic cholecystectomy by the following factors- Duration of surgery, Gall bladder perforation, Bile leak, Stone spillage.<b><o:p></o:p></b></span></p> <p class="MsoNormal" style="margin-bottom:12.0pt;line-height:115%;mso-pagination:&#10;none;mso-layout-grid-align:none;text-autospace:none"><b><span style="font-size:14.0pt;line-height:115%;font-family:&quot;Times New Roman&quot;,serif">Methods-
</span></b><span style="font-size:14.0pt;line-height:115%;font-family:&quot;Times New Roman&quot;,serif"> Patients with symptomatic gall stone disease were randomly assigned to electrocautery dissection (ECD) or harmonic scalpel dissection (HSD). The groups were comparable with respect to demographic characteristics, symptomatology, previous abdominal surgeries, comorbidities, preoperative ultrasonography findings and intraoperative complications. Both groups were compared for incidence of gallbladder perforation during dissection, bile leak, stone spillage and duration of surgery. </span><span style="font-size:14.0pt;&#10;line-height:115%;font-family:&quot;Times&quot;,serif"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:12.0pt;line-height:115%;mso-pagination:&#10;none;mso-layout-grid-align:none;text-autospace:none"><b><span style="font-size:14.0pt;line-height:115%;font-family:&quot;Times New Roman&quot;,serif">Results- </span></b><span style="font-size:14.0pt;line-height:115%;font-family:&quot;Times New Roman&quot;,serif">Out of 60 patients, the overall incidence of gallbladder perforation was 28.3%( 40% in the electrocautery vs 16.7% in the harmonic dissection group, p=0.045). Bile leak occurred in 40.0% of patients in the electrocautery group and 16.7% of patients in the harmonic dissection group (p=0.045). And duration of surgery (p=0.001) was longer in the ECD than the HSD group. There were no statistical difference in stone spillage between the groups (p=0.62). </span><span style="font-size:14.0pt;line-height:115%;font-family:&quot;Times&quot;,serif"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:12.0pt;line-height:115%;mso-pagination:&#10;none;mso-layout-grid-align:none;text-autospace:none"><b><span style="font-size:14.0pt;line-height:115%;font-family:&quot;Times New Roman&quot;,serif">Conclusion- </span></b><span style="font-size:14.0pt;line-height:115%;font-family:&quot;Times New Roman&quot;,serif">HSD is safe and effective, and it improves the operative course if laparoscopic cholecystectomy by reducing the incidence of gallbladder perforation and duration of surgery.&nbsp;</span><b><span style="font-size:14.0pt;line-height:115%;font-family:&quot;Times&quot;,serif"><o:p></o:p></span></b></p>