Laparoscopic cholecystectomy using ultrasonically activated coagulating shears

Ultrasonic energy has recently been used for surgical cutting and coagulati ng. A prospective randomized study was undertaken to determine the effectiv eness of ultrasonic energy versus monopolar electrosurgery in human laparos copic cholecystectomy. Two hundred patients were enrolled and randomized in to two groups of 100 patients each. Group A patients underwent laparoscopic cholecystectomy with monopolar electrocautery. Group B patients underwent laparoscopic cholecystectomy with ultrasonically activated shears. In 18 ca ses of this group, the cystic artery was coagulated and cut without clips. Subhepatic closed drainage was left for 24 h in patients who were candidate s for oozing of blood or leakage of bile. The median operating time was 45 min in group A and 37 min in group B. Subhepatic drainage was left in 37 pa tients of group A and 26 of group B. The median blood loss was 14 mi in gro up A and 2 mi in group B, while 3 patients of group A and none of group B h ad bile leakage from the bed of the gallbladder for 1, 1, and 6 days, respe ctively. Postoperative ultrasound examination showed a minor subhepatic flu id collection in 5 patients of group A and in 1 patient of group B. All the se collections were treated without drainage. The length of hospital stay w as 1.9 +/- 0.5 days in group A and 1.4 +/- 0.2 days in group B. Postoperati ve pain scores, nausea, and vomiting were equivalent in both groups. It is concluded that ultrasonically activated coagulating shears are safer, easie r to use, faster, and less prone to intraoperative complications and postop erative morbidity than monopolar electrocautery in laparoscopic cholecystec tomy.