Intracorporeal ligation of the cystic duct and artery during laparoscopic cholecystectomy: do we need the endoclips?

The introduction of laparoscopic cholecystectomy may have resulted in an in crease of cystic duct leaks, which could be attributed to the use of endocl ips. There are also reports of other complications associated with clips. C omplications associated with clips can be avoided by using intracorporeal l igation. The time necessary to complete the ligation was measured from prep aring the pedicle, to dividing the duct and artery in 170 cases. A 10 cm 2' 0' polyglactin tie was used to ligate the artery, proximally, and the cysti c duct, both proximally and distally, and the structures were divided. We t ook 2-8 min (mean time = 4.03) from the end of preparation of the cystic pe dicle to division of the structures using intracorporeal ligation. The cost of endoclips (ER 320-Ethicon) is approximately pound 152 per patient. The polyglactin ligature costs <pound 1. Ligation of the cystic duct and artery is safe and cost-effective. It does not add significantly to the operative time. Training should improve the skills necessary for secure intracorpore al knots, reducing the dependence on expensive disposable instruments.