Comparative Study of Conventional Electrocautery Versus Ultrasonic Dissector in Laparoscopic Cholecystectomy
Background: Laparoscopic cholecystectomy (LC) is very commonly performed for removal of gallstones. In routine, ultrasonic devices are used for laparoscopy involving the deeper operating fields, while electrosurgical devices are preferred for LC. However, nowadays both of these devices are used for LC. The objective of this study was to compare the surgical outcomes of ultrasonic dissector over conventional electrocautery in patients planned for LC.
Material and Methods: This non-randomized clinical trial was conducted in general surgery unit, Jinnah hospital Lahore. The study duration was 15th January 2015 to 31st December 2016. In group A (n=100), patients were operated through three-port standard laparoscopic cholecystectomy and conventional electrosurgical cautery was used for dissection. While in group B (n=50), patients were operated through single incision laparoscopic surgery (SILS) and Harmonic dissector was used for sealing of cystic artery and cystic duct. SPSS version 23 was used for data analysis. Complications between electrocautery and ultrasonic dissector were compared using chi-square test/Fischer exact test and operative time was compared using student’s t-test with p-value ≤ 0.05 considered as statistically significant.
Results: Out of 150 patients planned for laparoscopic cholecystectomy, 33 (22%) were males and 117 (78%) females. The mean age was 40±6.45 years with an age range of 12-80 years. In group A, intraoperative gall bladder perforation was found in 5 patients whereas in group B, there was only one patient with perforation. A total of 4 cases were converted to open cholecystectomy in group A due to difficult dissection in Calot’s triangle as compared to 1 case in group B. In group A, 3 cases had postoperative bile leakage in the drain. In two patients it settled over a period of 3 days. About 03 cases had wound infection in group A and 1 in group B. Mean operative time in group A was 42.2±8.93 minutes versus 35.7±4.85 minutes in group B (p-value 0.001).
Conclusion: In this study, the rate of post-operative complications was similar between the two groups, but operative time was significantly shorter in the group B. Harmonic dissector enabled easy dissection of tissues with good hemostasis and less trafficking of instrument, avoiding use of clips and sutures during minimal invasive surgery.
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