Laparoscopic cholecystectomy with Harmonic scalpel

BACKGRUOND: Laparoscopic cholecystectomy is considered the “gold standard” in the treatment of symptomatic gallbladder lithiasis. Nevertheless, there are some pitfalls associated with the use of monopolar hook such as risk of thermal injuries and biliary complications. The ultrasonically activated scalpel – Harmonic ® - (Ethicon Endo Surgery INC - Johnson & Johnson Medical SPA) has been used in gallbladder dissection and enables to divide both vessels and cystic duct while reducing the risk of thermal injuries. METHODS:During a period of 2 years, in a personal series involving 95 consecutive patients, the Harmonic was used as the sole instrument for division of both cystic artery and duct and dissection. The mean hospital stay, procedure duration and complications, were compared with a homogenous control group treated with monopolar electrosurgery and clips.RESULTS:Neither major complications nor bile ducts injuries were detected in both groups and no statistically significant difference was found in the incidence of postoperative complications. Instead the mean operative time was significantly shorter in the Harmonic group.CONCLUSIONS:The Harmonic is save and effective and represents an alternative to clips, providing a complete hemo-biliary stasis. Even if no differences were found regarding postoperative complications, Harmonic stands for a better alternative able to guarantee shorter operative time and cost savings which both derive from the use of a unique instrument.