Laparoscopic cholecystectomy (LC) is the “gold standard” in the treatment of symptomatic gallbladder lithiasis. Monopolar hook, i.e., used currently is associated with some complications, such as the risk of thermal injuries and biliary complications. The ultrasonically activated (harmonic) scalpel has been increasingly used for dissection of the gallbladder and for division of vessels and the cystic duct, because it reduces the risk of thermal injuries with encouraging results.

In this prospective study, 60 patients with gallbladder stones were planned to do LC. Patients were randomly assigned to either group I, including 30 patients who were subjected to traditional LC using cautery and clip applier, or to group II, including 30 planned for clipless cholecystectomy using harmonic (Ethicon Endosurgery Ultracision Harmonic Scalpel, Generator 300).

Neither minor nor major bile leaks were encountered in either groups. Similarly, no bile-duct injuries were encountered in the present study. The incidence of gallbladder perforation was less in group II. Operative time was significantly shorter in group II (p = 0.032). Mean hospital stay was significantly less in group II (p = 0.046). No statistically significant difference was found in the incidence of postoperative complications between both groups.

The harmonic shears are as safe and effective as the commonly used clip and cautery technique in achieving safe closure and division of the cystic duct in the LC. Further, it provides a superior alternative to the currently used highfrequency monopolar technology in terms of shorter operative time and lower incidence of gallbladder perforation.

Abdelhady MH, Salama AF. Clipped vs Clipless Laparoscopic Cholecystectomy using the Ultrasonically Activated (Harmonic) Scalpel. World J Lap Surg 2017;10(1):17-21.