HARMONIC SCALPEL VERSUS ELECTROCAUTERY ASSISTED DISSECTION IN LAPAROSCOPIC CHOLECYSTECTOMY: A REVIEW
Dr. Ashish Thakur, Dr. R. S. Jhobta, Dr. Ramesh Kaundal and Dr. Seema*
Introduction-Laparoscopic Cholecystectomy is the gold standard procedure for symptomatic cholelithiasis for years Phillipe Mouret of Lyon, France, performed his first laparoscopic cholecystectomy in 1987, followed by Francois Dubois of Paris, France, in 1988.[1,2] For a long time dissection is done with electrosurgical instruments which was first invented by William T Bovie, but with advancements of tools harmonic scalpel is showing promising results. Theoretical benefits for use of harmonic scalpel as dissection technique is less operative time, less bleeding, early post operative recovery, less spillage of stones, less chances of converting into open cholecystectomy, less pain post operatively, less amount of CO2 used. Methods-A comprehensive literature search was performed for trials and studies comparing harmonic scalpel assisted dissection vs electrocautery assisted dissection in laparoscopic cholecystectomy. Results were documented in form of duration of surgery, quantity of CO2 used, intra operative stone spillage, intra operative blood loss, post operative pain at 6 hour and 24 hour after the surgery, duration of hospital stay, any postoperative complications. Result- Operative time, intraoperative bleeding, intraoperative stone spillage, amount of CO2 used and post operative pain all were decreased with use of harmonic ace as compared to electrocautery in most of the studies , however post operative hospital stay and post operative complications are not statiscally reduced with use of harmonic ace as adissection tool. Conclusion-After reviewing various studies it is found that harmonic ace is a better dissecting instrument than electrocautery. Harmonic ace is a costly instrument so cost – benefit ratio is to be evaluated before its use in developing countries. Overall harmonic ace dominate electrocautery in all the testing fields and is a promising new dissection tool.
[Full Text Article]