Use of the ultrasonic dissecting scalpel in laparoscopic cholecystectomy

Background: We evaluated the use of the ultrasonically activated (harmonic) scalpel (HS) in the performance of laparoscopic cholecystectomy (LC), Methods: A total of 282 consecutive patients, 64 of whom had acute cholecys titis at the time of surgery, underwent LC using HS dissection. Indications for surgery included chronic pain (180 cases), episodes of acute cholecyst itis (89 cases), pancreatitis (five cases), and jaundice (seven cases). Twe nty-seven patients had preoperative endoscopic retrograde cholangiopancreat ography (ERCP). Results: The mean operating time was 29 +/- 9 mins. Eleven procedures were converted to open surgery, (four due to bleeding, six due to unclear anatom y, and one due to an inflammatory mass caused by gangrene/perforation). Com plications occurred in 14 patients. They included minor port site infection (four cases), pulmonary atelectasis (three cases), urinary retention (two cases), intraoperative cathetherization not routinely performed, bile leak (two cases, both from cystic duct; one of the cystic duct leaks occurred be cause of dislodgement of the occluding clip, the other may have been due to duct injury from the clip), pulmonary embolus (one case), and myocardial i nfarction (one case). Neither of the latter complications were fatal. One p atient required a postoperative transfusion due to a fall in hematocrit of 3.2 gr/dl. Conclusions. LC performed with the HS is feasible and effective. Operating time and blood loss were minimal, and the conversion rate was low (3.9%), T here were no bile duct injuries. Use of the HS makes dissection easier, the reby helping to reduce operative time and lower the need for conversion to open surgery.