Abstract

Background:
Laparoscopic cholecystectomy is the most common surgery performed for cholelithiasis. Monopolar electrocautery is being used in dissection for so many years. The ultrasonic technique of dissection is useful for safe and faster laparoscopic surgery.

Material and Method:
We conducted a prospective randomized control trial between classical electrocautery and ultrasonic group. The study included 100 patients over 9 months 12 days. The randomization was done using the envelop method and fifty cases were allocated in each group. The Statistical analysis was done by using the SPSS software (IBM SPSS for windows version 23.0, 2015, Armonk, NY: IBM Corp.). The ordinal data were described using median and Interquartile Range (IQR) and compared using the Chi-Square test and Mann-Whitney U test.

Result:
The operative time was significantly less in the ultrasonic group (p-value 0.017). VAS score for postoperative pain in the harmonic group was significantly less compared to the classic group (p-value 0.001). The incidence of gallbladder perforation was almost double in the classic group compared to the ultrasonic group but it was statistically not significant (p-value 0.74). The drain was inserted in 14 (28%) patients in the classic group while it was inserted in 7 (14%) patients in the harmonic group, but this difference was not statistically significant (p-value 0.086). The length of hospital stay was not significantly different in the two groups (p=0.89). All patients had no complications and conversion to open surgery

Conclusion:
Ultrasonic dissection of callot’s triangle and division of the cystic artery without clipping is safe in laparoscopic cholecystectomy. It has certain advantages over electrocautery like shorter operative time and less postoperative pain. However, no additional benefits to decrease the chances of gallbladder perforation, requirement of drain insertion and hospital stay.

Key words: Cholecystectomy, Electrocautery, Gallbladder perforation, Harmonic, Pain