Harmonic Scalpel versus Electrocautery and its Outcome in Laparoscopic Cholecystectomy: A Prospective Interventional Study

Abstract

Introduction: Laparoscopic cholecystectomy can now be performed safely and effectively due to various surgical tools that have significantly reduced intraoperative and postoperative problems. The Harmonic® Scalpel (HS) is a superior option to more conventional Electrocautery (EC) because it reduces temperatures, smoke, and lateral tissue damage. The Harmonic® Scalpel also lowers the risk of injury due to minimal heat dispersion. Due to less trauma, there is a decrease in both moderate and severe bleeding. It is hypothesised that the HS might be a more cost-effective alternative to employing a variety of disposable tools, such as scissors, a clipper, an EC hook, and a grasper. Aim: To compare the effectiveness and safety of the HS compared to traditional EC in achieving complete dissection and haemostasis during laparoscopic cholecystectomies. Materials and Methods: A prospective interventional study was conducted with 300 patients diagnosed with chronic calculous cholecystitis, admitted to a tertiary care hospital under Department of General Surgery, from November 2020 to October 2022. Patients were allocated to two groups, and the outcomes of laparoscopic cholecystectomy were compared between the usage of a HS and EC in Calot’s triangle dissection and Gallbladder (GB) dissection from the GB fossa. Descriptive data were represented through frequencies and percentages. The means of the two groups were compared using t-test, and categorical variables were compared using chi-square test. Results: The mean age was 46.53±13.740 years in the HS group, while it was 45.3±13.961 years in the EC group. The average duration of dissection with a HS was 52.84±6.167 minutes and 56.79±5.582 minutes in the EC group (p-value 0.001). A total of 67 (44.7%) patients in the HS group had minimal or no bleeding, while it was 23 (15.3%) patients in the EC group. GB perforation occurred in 13 (8.7%) patients in the HS group and in 26 (17.3%) patients in the EC group. Liver injury occurred in 2 (1.3%) patients in the HS group and in 6 (4%) patients in the EC group. Postoperative nausea and vomiting were reported in 20 (13.3%) and 72 (48%) patients in the HS and EC groups, respectively, in the first 48 hours. All these associations were found to be statistically significant (p-value 0.001). Conclusion: The present study found that the HS offers a hassle-free dissection without much incidence of intraoperative bleeding or surrounding tissue damage.

Keywords

• calot’s triangle
• chronic calculous cholecystitis
• gallbladder fossa
• intraoperative bleeding