www.ijcmr.com International Journal of Contemporary Medical Research ISSN (Online): 2393-915X; (Print): 2454-7379 | ICV (2015): 77.83 | Volume 3 | Issue 10 | October 2016 3043 Comparison of Laparoscopic Cholecystectomy Performed using Harmonic Scalpel as the Sole Instrument or by using Standard Clip and Electrocautery Technique Karnail Singh 1 , Sanjeev Gupta 2 , Vinod Kumar 3 , Vikas Garg 4 ORIGINAL RESEARCH ABSTRACT Introduction: Laparoscopic cholecystectomy using clips and cautery, has been the gold standard treatment for symptomatic cholelithiasis since long. But the technique still has areas requiring reinement, including complications of clips being dislodged and electrical arcing injuries, due to the use of monopolar electrocautery. This study was undertaken to demonstrate the eficacy and safety of the Harmonic scalpel as the sole instrument to achieve complete hemobiliary stasis. Material and methods: A comparative study was conducted at GMC Rajindra Hospital Patiala including sixty patients divided into two equal groups of 30 each, which underwent laparoscopic cholecystectomy using standard clip and cautery technique or the Harmonic scalpel (HS) technique. Harmonic scalpel was used to ligate and cut both the cystic duct and artery. Comparison was made with regard to the operative time, lens cleaning, intraoperative and postoperative complications. Results: The use of Harmonic scalpel results in shorter operative time and reduces the number of times lens requires cleaning, but there is no signiicant difference in intraoperative and postoperative complications in both group of patients. Conclusion: Harmonic scalpel is safe and effective in providing complete hemobiliary stasis, it signiicantly reduces the operative duration and the number of times lens is cleaned, hence making the surgeon more comfortable. Keywords: Laparoscopic cholecystectomy, Harmonic scalpel, Monopolar electrocautery. INTRODUCTION Laparoscopic cholecystectomy is the revolutionary new method for the treatment of gallstone disease and has now become the gold standard for the surgical treatment of symptomatic cholelithiasis. 1,2 The traditional laparoscopic cholecystectomy is commonly performed by means of dissector, the electrosurgical hook, spatula, and/or scissors, and this method has been used in most centers. Simple metal clips are frequently used to achieve cystic duct and artery closure. 3 Although the surgical clip was known to be a safe closure method, bile leakage due to clip displacement from the cystic duct stump is a potential complication of laparoscopic cholecystectomy. 4 There are many other complications that have been found to be associated with the use of the clips like accidental clipping of common bile duct leading to obstruction, strictures, slippage of clips etc. 5-8 Therefore, various new methods are now used to control the cystic artery like absorbable or non-absorbable sutures, Monopolar or Bipolar electro coagulation and Harmonic scalpel have also been used for this purpose but due to its high cost Harmonic scalpel has been used less frequently. 9 Designed as a safe alternative to electro cautery for the haemostatic dissection of tissue, the ultrasonically activated Harmonic scalpel was introduced into clinical use nearly a decade ago. Several studies have described the use of ultrasound dissection technology in the LC, which concluded that ultrasonic dissection was safe and easy to use. 10 Its technology relies on the application of ultrasound within the harmonic frequency range to tissues and allows two effects: ultrasonic coagulation and cavitational effects provided by a rapidly vibrating blade contacting various tissues. 11 the heat generated as a result of stress and friction is below 80 degree Celsius, as a result tissue charring and desiccation from loss of moisture is minimized. The cavitational or cutting effect is produced by a relatively sharp blade vibrating 55,500 times per second over a distance of 60–100 μm. It cuts the tissue by stretching it beyond its elastic limit and by breaking molecular bonds. Large series studies have demonstrated the effectiveness and safety of the use of the HS for dissection of the gallbladder. 12 The Harmonic scalpel is also an effective tool for closure of biliary ducts and vessels whose diameter is 4mm to 5mm (as certiied by the FDA in 2006). This study was undertaken to demonstrate the eficacy and safety of the Harmonic scalpel as the sole instrument to achieve complete hemobiliary stasis in the performance of Laparoscopic cholecystectomy. Moreover, the use of a single instrument during the whole procedure averts or decreases the risk of distant organ injuries. 13 Material and Methods A prospective randomized clinical trial was conducted in the department of surgery, Government Medical College (Rajindra Hospital) Patiala from November 2012 to November 2014 on 60 patients admitted with the diagnosis of symptomatic cholelithiasis that gave an informed consent and underwent elective laparoscopic cholecystectomy. Patients were randomly divided into 2 groups: the study group and control group with 30 patients each. In the study group, patients with symptomatic cholelithiasis underwent laparoscopic cholecystectomy using the harmonic scalpel (HS) to ligate and cut cystic artery and cystic duct as well as dissection of the liver bed, whereas in the control group patients were operated by conventional method using electrocautery and clips. Both the groups were 1 Associate Professor, 2 Assistant Professor, 3 Senior Resident, 4 Junior Resident Department of General Surgery, Government Medical College Patiala, Punjab, India Corresponding author: Karnail Singh, Associate Professor, Department of General Surgery, Government Medical College Patiala, Punjab, India How to cite this article: Karnail Singh, Sanjeev Gupta, Vinod Kumar, Vikas Garg. Comparison of laparoscopic cholecystectomy performed using harmonic scalpel as the sole instrument or by using standard clip and electrocautery Technique. International Journal of Contemporary Medical Research 2016;3(10):3043-3046.