الملخص

ABSTRACT Objective: To demonstrate the efficiency and safety of Harmonic scalpel in comparison with electrocautery for gallbladder dissection and hemostasis in laparoscopic cholecystectomy. Patients and methods: A prospective comparative, study was done at Al-Jamhori Teaching Hospital in Mosul, during the period from 1st of January 2010 to 1st of January 2012. Three hundred and twenty patients underwent laparoscopic cholecystectomy, the following criteria were applied for selection: they had chronic cholecystitis, no complaint at time of operation, age between 25 to 50 years, normal body weight, with American Score of Anesthesia (ASA) of 1 or 2, no previous upper abdominal operation, no, or well controlled hypertension or diabetes, gall bladder wall thickness with less than 6 mm by preoperative ultrasonography and all the patients were operated by the authors. The patients were divided into two groups according to the instrument used for dissection of gall bladder from its bed, the first group with electrocautery and second group with harmonic scalpel. The time needed for complete dissection and hemostasis started from spreading of Calot’s triangle till removal of gall bladder totally from its bed, was recorded. Any intra operative complications: bleeding, gallbladder perforation, slipped stones, or conversion were recorded. Results: The study included 320 patients, 172 patients belonged to the first group (electrocautery) and 148 patients belonged to second group (harmonic). For the first group, the median time was 17 minutes, the mean time was 17.7 minutes and the mode was 13 minutes, while that for second group, the median time was 14 minutes, with a mean time of 16 minutes and a mode of 14 minutes. Intra-operative bleeding was recorded in 34 (20%) for the first group and 17 (11%) for the second one. Gallbladder perforation was recorded in 26 (15%) patients and slipped stone in 12 (7%) patients in the electrocautery group and 13(9%) and 5 (3%) respectively in the harmonic group. No common bile duct injury was recorded in either group. Conversion was needed in 4 patients (1.3%), 3 (2%) patients belonged to the first group and one (06%) to the second group. Conclusion: Harmonic scalpel is very safe and effective instrument for dissection of gall bladder and hemostasis in laparoscopic cholecystectomy and can replace electrocautery for this purpose if available at operative theater. Keywords: Laparoscopic cholecystectomy, harmonic scalpel, electrocautery.