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Turial S, Schwind M, Nyiredi A. Evaluation of the Appropriate LigaSure™ Device to Transect the Appendix-A Comparison between 5 mm and 10 mm Laparoscopic Devices in an Ex Vivo Trial. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050927. [PMID: 37241159 DOI: 10.3390/medicina59050927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/03/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: A topic of greatinterest in the surgical field comprises cost and time reduction operative techniques with high efficiency rates. Thus, the aim of this paper is to evaluate whether a transection of the appendix using only a laparoscopic LigaSure™ device is feasible and, if so, which size of the laparoscopic device is optimal. Materials and Methods: Appendectomy specimens were sealed and cut using LigaSureTM V (5 mm) and LigaSure AtlasTM (10 mm) devices ex vivo. Analysis criteria included handling, resistance to bursting pressure of the appendicular stump (adequacy), eligibility, durability and airtightness. Results: Twenty sealed areas were measured. While the 5 mm instrument was not able to transect the appendix in one attempt in any of the cases, the 10 mm device could be applied successfully without any handling difficulties. The adequacy of the sealed area was rated as complete and dry in all 10 cases using the 10 mm device and as oozing in 8 of the cases using the 5 mm device. There was no leakage in terms of air and liquid tightness using the 10 mm device, in contrast to six sealed segments with air and liquid leakage when using the 5 mm device. The resistance to bursting pressure was on average 285 mmHg and 60.5 mmHg with the 10 mm and 5 mm devices, respectively. The durability and eligibility of the 10 mm device were rated as very sufficient in 9 of 10 cases (1 perforation) in contrast to the 5 mm device, where the sealing in 9 of 10 cases was not sufficient (9 perforations). Conclusions: Using the 10 mm laparoscopic LigaSure™ device for the transection of the appendix seems to be feasible, safe and resistant to 300 mmHg bursting pressure. The 5 mm LigaSure™ instrument is inadequate to seal the appendix in humans.
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Affiliation(s)
- Salmai Turial
- Department of Pediatric Surgery, Pediatric Trauma and Pediatric Urology, University Medical Centre Magdeburg, 39120 Magdeburg, Germany
| | - Martin Schwind
- Department of Pediatric Surgery, University Medical Centre Mainz, 55101 Mainz, Germany
| | - Alexandra Nyiredi
- Department of Pediatric Surgery, Pediatric Trauma and Pediatric Urology, University Medical Centre Magdeburg, 39120 Magdeburg, Germany
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Ortenzi M, Agresta F, Vettoretto N, Gerardi C, Allocati E, Botteri E, Montori G, Balla A, Arezzo A, Piatto G, Sartori A, Antoniou S, Podda M. Use of High Energy Devices (HEDs) versus electrocautery for laparoscopic cholecystectomy: a systematic review and meta-analysis of randomised controlled trials. Surg Endosc 2023:10.1007/s00464-023-10060-7. [PMID: 37074420 DOI: 10.1007/s00464-023-10060-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 04/01/2023] [Indexed: 04/20/2023]
Abstract
INTRODUCTION According to the literature, there is no clear definition of a High Energy Devices (HEDs), and their proper indications for use are also unclear. Nevertheless, the flourishing market of HEDs could make their choice in daily clinical practice arduous, possibly increasing the risk of improper use for a lack of specific training. At the same time, the diffusion of HEDs impacts the economic asset of the healthcare systems. This study aims to assess the efficacy and safety of HEDs compared to electrocautery devices while performing laparoscopic cholecystectomy (LC). MATERIALS AND METHODS On behalf of the Italian Society of Endoscopic Surgery and New Technologies, experts performed a systematic review and meta-analysis and synthesised the evidence assessing the efficacy and safety of HEDs compared to electrocautery devices while performing laparoscopic cholecystectomy (LC). Only randomised controlled trials (RCTs) and comparative observational studies were included. Outcomes were: operating time, bleeding, intra-operative and post-operative complications, length of hospital stay, costs, and exposition to surgical smoke. The review was registered on PROSPERO (CRD42021250447). RESULTS Twenty-six studies were included: 21 RCTs, one prospective parallel arm comparative non-RCT, and one retrospective cohort study, while three were prospective comparative studies. Most of the studies included laparoscopic cholecystectomy performed in an elective setting. All the studies but three analysed the outcomes deriving from the utilisation of US sources of energy compared to electrocautery. Operative time was significantly shorter in the HED group compared to the electrocautery group (15 studies, 1938 patients; SMD - 1.33; 95% CI - 1.89 to 0.78; I2 = 97%, Random-effect). No other statistically significant differences were found in the other examined variables. CONCLUSIONS HEDs seem to have a superiority over Electrocautery while performing LC in terms of operative time, while no difference was observed in terms of length of hospitalisation and blood loss. No concerns about safety were raised.
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Affiliation(s)
- Monica Ortenzi
- Department of General and Emergency Surgery, Polytechnic University of Marche, Ancona, Italy.
| | - Ferdinando Agresta
- Unit of General and Emergency Surgery, Vittorio Veneto Hospital, Vittorio Veneto, Treviso, Italy
| | - Nereo Vettoretto
- General Surgery, ASST Spedali Civili Di Brescia PO Montichiari, Montichiari, Brescia, Italy
| | - Chiara Gerardi
- Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Eleonora Allocati
- Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Emanuele Botteri
- General Surgery, ASST Spedali Civili Di Brescia PO Montichiari, Montichiari, Brescia, Italy
| | - Giulia Montori
- Unit of General and Emergency Surgery, Vittorio Veneto Hospital, Vittorio Veneto, Treviso, Italy
| | - Andrea Balla
- General and Minimally Invasive Surgery, Hospital "San Paolo", Civitavecchia, Rome, Italy
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Turin, Italy
| | - Giacomo Piatto
- Department of General Surgery, Ospedale Di Montebelluna, Montebelluna, Treviso, Italy
| | - Alberto Sartori
- Department of General Surgery, Ospedale Di Montebelluna, Montebelluna, Treviso, Italy
| | - Stavros Antoniou
- Department of Surgery, Mediterranean Hospital of Cyprus, Limassol, Cyprus
| | - Mauro Podda
- Department of Surgical Science, Emergency Surgery Unit, University of Cagliari, Cagliari, Italy
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Vettoretto N, Foglia E, Gerardi C, Lettieri E, Nocco U, Botteri E, Bracale U, Caracino V, Carrano FM, Cassinotti E, Giovenzana M, Giuliani B, Iossa A, Milone M, Montori G, Peltrini R, Piatto G, Podda M, Sartori A, Allocati E, Ferrario L, Asperti F, Songia L, Garattini S, Agresta F. High-energy devices in different surgical settings: lessons learnt from a full health technology assessment report developed by SICE (Società Italiana di Chirurgia Endoscopica). Surg Endosc 2023; 37:2548-2565. [PMID: 36333498 PMCID: PMC9638482 DOI: 10.1007/s00464-022-09734-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The present paper aims at evaluating the potential benefits of high-energy devices (HEDs) in the Italian surgical practice, defining the comparative efficacy and safety profiles, as well as the potential economic and organizational advantages for hospitals and patients, with respect to standard monopolar or bipolar devices. METHODS A Health Technology Assessment was conducted in 2021 assuming the hospital perspective, comparing HEDs and standard monopolar/bipolar devices, within eleven surgical settings: appendectomy, hepatic resections, colorectal resections, cholecystectomy, splenectomy, hemorrhoidectomy, thyroidectomy, esophago-gastrectomy, breast surgery, adrenalectomy, and pancreatectomy. The nine EUnetHTA Core Model dimensions were deployed considering a multi-methods approach. Both qualitative and quantitative methods were used: (1) a systematic literature review for the definition of the comparative efficacy and safety data; (2) administration of qualitative questionnaires, completed by 23 healthcare professionals (according to 7-item Likert scale, ranging from - 3 to + 3); and (3) health-economics tools, useful for the economic evaluation of the clinical pathway and budget impact analysis, and for the definition of the organizational and accessibility advantages, in terms of time or procedures' savings. RESULTS The literature declared a decrease in operating time and length of stay in using HEDs in most surgical settings. While HEDs would lead to a marginal investment for the conduction of 178,619 surgeries on annual basis, their routinely implementation would generate significant organizational savings. A decrease equal to - 5.25/-9.02% of operating room time and to - 5.03/-30.73% of length of stay emerged. An advantage in accessibility to surgery could be hypothesized in a 9% of increase, due to the gaining in operatory slots. Professionals' perceptions crystallized and confirmed literature evidence, declaring a better safety and effectiveness profile. An improvement in both patients and caregivers' quality-of-life emerged. CONCLUSIONS The results have demonstrated the strategic relevance related to HEDs introduction, their economic sustainability, and feasibility, as well as the potentialities in process improvement.
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Affiliation(s)
- Nereo Vettoretto
- U.O.C. Chirurgia Generale, ASST Spedali Civili di Brescia P.O. Montichiari, Ospedale di Montichiari, Chirurgia, V.le Ciotti 154, 25018, Montichiari, BS, Italy.
| | - Emanuela Foglia
- Centre for Health Economics, Social and Health Care Management, Università Carlo Cattaneo - LIUC, Castellanza, Italy
| | - Chiara Gerardi
- Mario Negri Institute for Pharmacological Research IRCCS, Milan, Italy
| | - Emanuele Lettieri
- Dipartimento di Ingegneria Gestionale, Politecnico di Milano, Milan, Italy
| | - Umberto Nocco
- S.C. Ingegneria Clinica, ASST Grande Ospedale Metropolitano Niguarda and Associazione Italiana Ingegneri Clinici, Milan, Italy
| | - Emanuele Botteri
- U.O.C. Chirurgia Generale, ASST Spedali Civili di Brescia P.O. Montichiari, Ospedale di Montichiari, Chirurgia, V.le Ciotti 154, 25018, Montichiari, BS, Italy
| | - Umberto Bracale
- U.O.C. Chirurgie Generale e Oncologica Mini Invasiva, A.O.U. Policlinico Federico II, Naples, Italy
| | - Valerio Caracino
- U.O.C. Chirurgia Generale e d'Urgenza, AUSL Pescara, Pescara, Italy
| | | | - Elisa Cassinotti
- Chirurgia Generale, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Giovenzana
- Unit of HepatoBilioPancreatic and Digestive Surgery, Ospedale San Paolo, University of Milan, Milan, Italy
| | - Beatrice Giuliani
- Unit of HepatoBilioPancreatic and Digestive Surgery, Ospedale San Paolo, University of Milan, Milan, Italy
| | - Angelo Iossa
- Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, University of Rome Sapienza Polo Pontino, Rome, Italy
| | - Marco Milone
- U.O.C. Chirurgia Generale, Azienda Ospedaliera Universitaria Federico II di Napoli, Naples, Italy
| | - Giulia Montori
- U.O.C. Chirurgia Generale, Ospedale di Vittorio Veneto, Treviso, Italy
| | - Roberto Peltrini
- U.O.C. Chirurgie Generale e Oncologica Mini Invasiva, A.O.U. Policlinico Federico II, Naples, Italy
| | - Giacomo Piatto
- UOC Chirurgia Generale e d'Urgenza, Ospedale di Montebelluna (TV), AULSS 2 Marca Trevigiana, Treviso, Italy
| | - Mauro Podda
- Dipartimento di Scienze Chirurgiche, Università degli Studi di Cagliari, Cagliari, Italy
| | - Alberto Sartori
- UOC Chirurgia Generale e d'Urgenza, Ospedale di Montebelluna (TV), AULSS 2 Marca Trevigiana, Treviso, Italy
| | - Eleonora Allocati
- Mario Negri Institute for Pharmacological Research IRCCS, Milan, Italy
| | - Lucrezia Ferrario
- Centre for Health Economics, Social and Health Care Management, Università Carlo Cattaneo - LIUC, Castellanza, Italy
| | - Federica Asperti
- Centre for Health Economics, Social and Health Care Management, Università Carlo Cattaneo - LIUC, Castellanza, Italy
| | - Letizia Songia
- S.C. Ingegneria Clinica, ASST Grande Ospedale Metropolitano Niguarda and Associazione Italiana Ingegneri Clinici, Milan, Italy
- SC Ingengeria Clinica, ASST di Lecco, Lecco, Italy
| | - Silvio Garattini
- Centre for Health Economics, Social and Health Care Management, Università Carlo Cattaneo - LIUC, Castellanza, Italy
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Zhu H, Liu D, Zhou D, Wu J, Yu Y, Jin Y, Ye D, Ding C, Zhang X, Huang B, Peng S, Li J. Effectiveness of no drainage after elective day-case laparoscopic cholecystectomy, even with intraoperative gallbladder perforation: a randomized controlled trial. Langenbecks Arch Surg 2023; 408:112. [PMID: 36856748 DOI: 10.1007/s00423-023-02846-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 02/18/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND Laparoscopic cholecystectomy (LC) has been carried out as day-case surgery. Current guidelines do not mention the role of drainage after LC. In particular, data stay blank with no prospective study on drainage management when gallbladder perforation (GP) accidentally occurs intraoperatively. METHODS A randomized controlled trial was conducted to compare clinical outcomes of drainage and no drainage after elective day-case LC. Intraoperative GP was recorded. The primary and secondary outcomes were major and minor complications, respectively. RESULTS Two hundred patients were randomized. No major complications occurred in either group. In secondary outcomes, nausea/vomiting, pain, hospital stay, and cost were similar in the drainage group and no drainage group; postoperative fever, WBC, and CRP levels were significantly lower in the no drainage group. GP occurred in 32 patients. Male patients with higher BMI and CRP and abdominal pain within 1 month were more likely to occur GP. Subgroup analysis of GP, primary outcomes, and most secondary outcomes had no difference. Postoperative WBC and CRP were higher in the drainage group. Postoperative fever occurred in 63 patients. Univariate analysis of fever showed that blood loss, drainage, postoperative WBC, CRP, and hospital stay were significant. Multivariable logistic regression analysis demonstrated that drainage was an independent risk factor for fever after LC (OR 3.418, 95% CI 1.392-8.390; p = 0.007). CONCLUSIONS No drainage after elective day-case LC is safe and associated with fewer complications, even in intraoperative GP. The trial proves that drainage is an independent risk factor for postoperative fever. The use of a drain after LC may lead to an unsuccessful day-case procedure by causing fever, elevated CRP, and extended hospital stay (NCT03909360).
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Affiliation(s)
- Huanbing Zhu
- Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Daren Liu
- Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Donger Zhou
- Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Jinhong Wu
- Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Yuanquan Yu
- Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Yun Jin
- Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Dan Ye
- Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Chao Ding
- Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Xiaoxiao Zhang
- Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Bingying Huang
- Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Shuyou Peng
- Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Jiangtao Li
- Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China.
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5
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Muacevic A, Adler JR. Harmonic Scalpel Versus Clips for Ligation of Cystic Duct in Laparoscopic Cholecystectomy: A Systematic Review. Cureus 2022; 14:e32335. [PMID: 36505958 PMCID: PMC9732503 DOI: 10.7759/cureus.32335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2022] [Indexed: 12/13/2022] Open
Abstract
The gold standard treatment for benign gallbladder disease is laparoscopic cholecystectomy (LC). LC is commonly performed using monopolar diathermy with ligation of the cystic duct and artery with clips. The aim of the current systematic review was to compare harmonic scalpel (HS) with clips in LC. Eligible studies were identified from PubMed, Cochrane library, Embase and Medline and meta-analysis was conducted using Review Manager 5.4. The primary outcome evaluated was bile leak while secondary outcomes evaluated were overall postoperative complications, operative time, conversion to open surgery and gall bladder perforation. Eight randomized control trials met the eligibility criteria which included a total of 1,205 patients. There was no statistically significant difference between the two groups in terms of bile leak (p = 0.56, I2=0%). With respect to the operative time (p = 0.004, I2=97%), conversion to open surgery (p = 0.02, I2=0%) and gall bladder perforation (p = 0.0001, I2=26%) HS was superior to clips. HS is an acceptable alternative to the use of clips when ligating the cystic duct.
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Tan Z, Wan R, Qian H, Xie P. Migration of Hem-o-lok clip into the common hepatic duct after laparoscopic bile duct exploration: A case report. Clin Case Rep 2021; 9:e04834. [PMID: 34584709 PMCID: PMC8455851 DOI: 10.1002/ccr3.4834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/24/2021] [Accepted: 08/30/2021] [Indexed: 01/07/2023] Open
Abstract
Hem-o-lok clip migration into the bile duct can lead to stone formation and granulation tissue hyperplasia. This report discusses a case wherein four clips migrated into the bile duct after laparoscopic bile duct exploration.
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Affiliation(s)
- Zhenhua Tan
- Department of Hepatobiliary SurgeryHuzhou Central HospitalZhejiang University Huzhou HospitalAffiliated Central Hospital of Huzhou Teachers CollegeHuzhouChina
| | - Renrui Wan
- Department of Hepatobiliary SurgeryHuzhou Central HospitalZhejiang University Huzhou HospitalAffiliated Central Hospital of Huzhou Teachers CollegeHuzhouChina
| | - Hai Qian
- Department of Hepatobiliary SurgeryHuzhou Central HospitalZhejiang University Huzhou HospitalAffiliated Central Hospital of Huzhou Teachers CollegeHuzhouChina
| | - Ping Xie
- Department of Hepatobiliary SurgeryHuzhou Central HospitalZhejiang University Huzhou HospitalAffiliated Central Hospital of Huzhou Teachers CollegeHuzhouChina
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7
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Kihara Y, Takeda Y, Ohmura Y, Katsura Y, Shinke G, Ikeshima R, Katsuyama S, Kawai K, Hiraki M, Sugimura K, Masuzawa T, Takeno A, Hata T, Murata K. Migration of non-absorbable polymer clips in hepato-biliary-pancreatic surgery: a report of four cases. Surg Case Rep 2021; 7:183. [PMID: 34390417 PMCID: PMC8364615 DOI: 10.1186/s40792-021-01269-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 08/09/2021] [Indexed: 11/19/2022] Open
Abstract
Background Ligation clips are used for vessel or tissue ligation in surgery. Although previous reports have described the migration of metallic clips after hepato-biliary-pancreatic surgery, very few reports have described the migration of non-absorbable polymer clips (NAPCs: Hem-o-Lok). Case presentation We present 4 cases of NAPC migration that occurred after laparoscopic surgery. Case 1 was an 81-year-old woman that had undergone a laparoscopic right hemihepatectomy for an intrahepatic bile duct cyst adenocarcinoma at the age of 79 years. Two years after the operation, she underwent an upper gastrointestinal endoscopy to investigate epigastric pain. The endoscopy showed NAPCs lodged at the anterior side of the duodenal bulb. Case 2 was an 80-year-old man that had undergone a laparoscopic cholecystectomy for choledocholithiasis at the age of 77 years. Three years after the operation, follow-up computed tomography and magnetic resonance cholangiopancreatography (MRCP) imaging indicated a mass in the upper bile duct. After a laparoscopic bile duct resection and reconstruction, an NAPC was found inside the inflammatory pseudotumor. Case 3 was a 63-year-old man that had undergone laparoscopic liver S4b and S5 resections and lymph node dissection for gallbladder cancer. Three months after the operation, follow-up MRCP imaging suggested a bile duct stenosis. An endoscopic retrograde cholangiopancreatography (ERCP) was performed, and an NAPC was found inside the bile duct. Case 4 was a 74-year-old man that had undergone a laparoscopic S5 segmentectomy, S7 partial liver resection, and cholecystectomy for liver metastasis of lung cancer and cholelithiasis. A trans-cystic drainage tube was inserted, and it was ligated and fixed with NAPCs. Three months after the operation, follow-up MRCP imaging showed common bile duct stones (CBDS). An ERCP was performed, and two NAPCs were found with the CBDS. Conclusions Few previous reports have described complications due to NAPC migration after hepato-biliary-pancreatic surgery. However, with the widespread use of NAPC, postoperative complications due to NAPC migration are expected to increase in the near future. The differential diagnosis of complications should include potential NAPC migration in patients that have undergone laparoscopic surgery.
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Affiliation(s)
- Yukari Kihara
- Department of Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Yutaka Takeda
- Department of Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan.
| | - Yoshiaki Ohmura
- Department of Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Yoshiteru Katsura
- Department of Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Go Shinke
- Department of Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Ryo Ikeshima
- Department of Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Shinsuke Katsuyama
- Department of Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Kenji Kawai
- Department of Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Masayuki Hiraki
- Department of Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Keijiro Sugimura
- Department of Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Toru Masuzawa
- Department of Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Atsushi Takeno
- Department of Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Taishi Hata
- Department of Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Kohei Murata
- Department of Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan
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8
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Kannan A, Tara A, Quadir H, Hakobyan K, Gaddam M, Ojinnaka U, Ahmed Z, Dominic JL, Kantamaneni K, Went TR, Mostafa JA. The Outcomes of the Patients Undergoing Harmonic Scalpel Laparoscopic Cholecystectomy. Cureus 2021; 13:e15622. [PMID: 34277239 PMCID: PMC8275056 DOI: 10.7759/cureus.15622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 06/13/2021] [Indexed: 12/19/2022] Open
Abstract
Laparoscopic cholecystectomy has replaced conventional open cholecystectomy and has become the gold standard surgery for gall bladder pathologies. The harmonic scalpel is one of the instruments used to dissect and coagulate. Most surgeons accept the usage of the harmonic scalpel in laparoscopic cholecystectomy. The other standard method is electrocoagulation by electrocautery. The harmonic scalpel cholecystectomy has several advantages over other methods of laparoscopic cholecystectomy. Electrocoagulation by electrocautery produces smoke which can result in damage to lateral tissues, including the gall bladder. The clips are used along with electrocoagulation to seal cystic duct and cystic artery before dissection. There are various studies about bile leakage in the case of clip application. The harmonic scalpel uses ultrasonic energy to achieve hemostasis without bleeding, dissection, and gallbladder removal from the liver bed during laparoscopic surgery by causing coagulation of proteins. The patient outcome variables such as postoperative pain, duration of hospital stay, postoperative nausea and vomiting, surgical site infections, and other complications have not been compared in review articles. In this review, we collected the information from previously published studies and reviewed the outcomes of patients undergoing harmonic scalpel cholecystectomy. Harmonic scalpel cholecystectomy reduces the duration of hospital stay, duration of operation, intraoperative and postoperative complications, and postoperative pain. Thus the harmonic scalpel can be used instead of other instruments as it has better patient outcomes.
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Affiliation(s)
- Amudhan Kannan
- General Surgery, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Anjli Tara
- General Surgery, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.,General Surgery, Stony Brook Medicine, Southampton Hospital, Southampton, USA
| | - Huma Quadir
- Internal Medicine/Family Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.,Neurology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Knkush Hakobyan
- Diagnostic Radiology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Mrunanjali Gaddam
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Ugochi Ojinnaka
- Family Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Zubayer Ahmed
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Jerry Lorren Dominic
- General Surgery, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.,General Surgery/Orthopedic Surgery, Cornerstone Regional Hospital, South Texas Health System, Edinburg, USA.,General Surgery, Stony Brook Medicine, Southampton Hospital, Southampton, USA
| | - Ketan Kantamaneni
- Vascular Surgery, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Terry R Went
- General Surgery, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Jihan A Mostafa
- Psychiatry, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Clipless laparoscopic cholecystectomy is a better technique in reducing intraoperative bleeding. Ann Med Surg (Lond) 2021; 62:431-434. [PMID: 33643641 PMCID: PMC7889432 DOI: 10.1016/j.amsu.2021.01.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/11/2021] [Accepted: 01/11/2021] [Indexed: 11/22/2022] Open
Abstract
A best evidence topic has been constructed using a described protocol. The three-part question addressed was: In patients undergoing cholecystectomy is the clipless laparoscopic cholecystectomy associated with lower rates of intraoperative bleeding compared to conventional cholecystectomy? The search has been devised and 5 studies were deemed to be suitable to answer the question. The outcome assessed was the rate intraoperative blood loss in clipless cholecystectomy compared to conventional laparoscopic cholecystectomy. Authors recommend adopting clipless laparoscopic cholecystectomy especially in patients with high risk of intraoperative bleeding. Perioperative Bleeding with laparoscopic cholecystectomy can be an troublesome especially in high risk patients. Clipless laparoscopic cholecystectomy entails using energy device to dissect and to seal the cystic duct and artery. Clipless cholecystectomy can offer a sensible solution for this particular situations.
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10
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Abounozha S, Ibrahim R, Alshahri T. Is the rate of bile leak higher in clipless laparoscopic cholecystectomy compared to conventional cholecystectomy? Ann Med Surg (Lond) 2021; 62:186-189. [PMID: 33532068 PMCID: PMC7829075 DOI: 10.1016/j.amsu.2021.01.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/11/2021] [Accepted: 01/11/2021] [Indexed: 11/30/2022] Open
Abstract
A best evidence topic has been constructed using a described protocol. The three-part question addressed was: In patients undergoing cholecystectomy is the clipless laparoscopic cholecystectomy is associated with higher risk of bile leak compared to conventional cholecystectomy? The search has been devised and 6 studies were deemed to be suitable to answer the question. The outcome assessed was the rate of bile leak in clipless cholecystectomy compared to conventional laparoscopic cholecystectomy. Authors found that the rates of bile leak in clipless laparoscopic cholecystectomy is comparable to conventional technique. Clipless cholecystectomy is feasible and safe.
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Affiliation(s)
- Sabry Abounozha
- Northumbria Healthcare NHS Foundation trust, Northumbria, UK
| | | | - Talal Alshahri
- Imam Abdulrahman Alfaisal University Hospital, Riyadh, Saudi Arabia
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11
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Less Pain and Reduced Risk of Early Postoperative Ileus After Clipless Versus Conventional Laparoscopic Appendectomy. Surg Laparosc Endosc Percutan Tech 2019; 29:543-547. [PMID: 31568256 DOI: 10.1097/sle.0000000000000721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Laparoscopic appendectomy (LA) is perceived as a procedure requiring a short hospital stay; however, some patients require prolonged hospitalization because of postoperative ileus and pain; therefore, we introduced clipless LA, using only an ultrasonic energy device only for coagulation. A total of 1013 patients (clipless LA; n=290 and conventional LA; n=723) who underwent LA at our hospital between January 2015 and February 2018 were analyzed. The mean operative time was shorter (P<0.001), and postoperative pain score at 24 hours was lower (P<0.001) for clipless than for conventional LA. There were no significant differences in postoperative complications, except with regard to early postoperative ileus (clipless LA; 18.1% vs. conventional LA; 31.6%, P=0.025), and the operative method had significantly influenced early postoperative ileus (relative risk, 0.505; 95% confidence interval, 0.257-0.994; P=0.048). Clipless LA is comparable to conventional LA with regard to operative safety but results in significantly less pain and postoperative ileus.
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12
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Roh YJ, Kim JW, Jeon TJ, Park JY. Common bile duct stone development due to a Hem-o-lok clip migration: a rare complication of laparoscopic cholecystectomy. BMJ Case Rep 2019; 12:12/7/e230178. [PMID: 31352393 DOI: 10.1136/bcr-2019-230178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Surgical clip migration is a rare complication of laparoscopic cholecystectomy (LC). Surgical clips migrating into the common bile duct (CBD) can lead to stone formation and obstruction. Here, we report a case of acute cholangitis caused by surgical Hem-o-lok clip migration into the bile duct with stone formation 13 months after LC. A 65-year-old man who underwent LC presented with upper abdominal pain and fever for 3 days. Abdominal CT scan showed a radiopaque material in the CBD, diffuse wall thickening and dilatation of intrahepatic and extrahepatic duct. Emergency percutaneous transhepatic biliary drainage was performed. Twodays later, an endoscopic retrograde cholangio-pancreatography was implemented, and muddy stones and one surgical clip were successfully removed by extraction balloon catheter.
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Affiliation(s)
- Yong Jun Roh
- Department of Internal Medicine, Inje University Sanggye Paik Hospital, Nowon-gu, Korea
| | - Jong Whan Kim
- Department of Internal Medicine, Inje University Sanggye Paik Hospital, Nowon-gu, Korea
| | - Tae Joo Jeon
- Department of Internal Medicine, Inje University Sanggye Paik Hospital, Nowon-gu, Korea
| | - Ji Young Park
- Department of Internal Medicine, Inje University Sanggye Paik Hospital, Nowon-gu, Korea
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Abstract
The incidence of biliary injury after laparoscopic cholecystectomy (LC) has shown a declining trend though it may still be twice that as with open cholecystectomy. Major biliary or vasculobiliary injury is associated with significant morbidity. As prevention is the best strategy, the concept of a culture of safe cholecystectomy has been recently introduced to educate surgeons and apprise them of basic tenets of safe performance of LC. Various aspects of safe cholecystectomy include: (1) thorough knowledge of relevant anatomy, various anatomical landmarks, and anatomical variations; (2) an understanding of the mechanisms involved in biliary/vascular injury, the most important being the misidentification injury; (3) identification of various preoperative and intraoperative predictors of difficult cholecystectomy; (4) proper gallbladder retraction; (5) safe use of various energy devices; (6) understanding the critical view of safety, including its doublet view and documentation; (7) awareness of various error traps (e.g., fundus first technique); (8) use of various bailout strategies (e.g., subtotal cholecystectomy) in difficult gallbladder cases; (9) use of intraoperative imaging techniques (e.g., intraoperative cholangiogram) to ascertain correct anatomy; and (10) understanding the concept of time-out. Surgeons should be facile with these aspects of this culture of safety in cholecystectomy in an attempt to reduce the incidence of biliary/vascular injury during LC.
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Affiliation(s)
- Vishal Gupta
- Department of Surgical Gastroenterology, Shatabdi Hospital Phase 1, King George's Medical University, Lucknow 226003, Uttar Pradesh, India.
| | - Gaurav Jain
- Transplant and HPB Surgery, the Iowa Clinic-Iowa Methodist Hospital, Des Moines, IA 50309, United States
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Gupta V, Jain G. Safe laparoscopic cholecystectomy: Adoption of universal culture of safety in cholecystectomy. World J Gastrointest Surg 2019; 11:62-84. [PMID: 30842813 PMCID: PMC6397793 DOI: 10.4240/wjgs.v11.i2.62] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 01/06/2019] [Accepted: 01/23/2019] [Indexed: 02/06/2023] Open
Abstract
The incidence of biliary injury after laparoscopic cholecystectomy (LC) has shown a declining trend though it may still be twice that as with open cholecystectomy. Major biliary or vasculobiliary injury is associated with significant morbidity. As prevention is the best strategy, the concept of a culture of safe cholecystectomy has been recently introduced to educate surgeons and apprise them of basic tenets of safe performance of LC. Various aspects of safe cholecystectomy include: (1) thorough knowledge of relevant anatomy, various anatomical landmarks, and anatomical variations; (2) an understanding of the mechanisms involved in biliary/vascular injury, the most important being the misidentification injury; (3) identification of various preoperative and intraoperative predictors of difficult cholecystectomy; (4) proper gallbladder retraction; (5) safe use of various energy devices; (6) understanding the critical view of safety, including its doublet view and documentation; (7) awareness of various error traps (e.g., fundus first technique); (8) use of various bailout strategies (e.g., subtotal cholecystectomy) in difficult gallbladder cases; (9) use of intraoperative imaging techniques (e.g., intraoperative cholangiogram) to ascertain correct anatomy; and (10) understanding the concept of time-out. Surgeons should be facile with these aspects of this culture of safety in cholecystectomy in an attempt to reduce the incidence of biliary/vascular injury during LC.
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Affiliation(s)
- Vishal Gupta
- Department of Surgical Gastroenterology, Shatabdi Hospital Phase 1, King George’s Medical University, Lucknow 226003, Uttar Pradesh, India
| | - Gaurav Jain
- Transplant and HPB Surgery, the Iowa Clinic-Iowa Methodist Hospital, Des Moines, IA 50309, United States
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15
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Ai XM, Ho LC, Yang NY, Han LL, Lu JJ, Yue X. A comparative study of ultrasonic scalpel (US) versus conventional metal clips for closure of the cystic duct in laparoscopic cholecystectomy (LC): A meta-analysis. Medicine (Baltimore) 2018; 97:e13735. [PMID: 30572514 PMCID: PMC6320032 DOI: 10.1097/md.0000000000013735] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND laparoscopic cholecystectomy (LC) has become the gold standard surgery for benign gallbladder diseases. Metal clips are conventionally used to secure the cystic duct and artery, while monopolar electrocautery (ME) predominates during laparoscopic dissection. ultrasonic scalpel (US) has already been explored for sealing the cystic duct and artery as a sole instrument, which has been regarded as a reasonable alternative to clips. The aim of this study was to investigate the safety and effectiveness of US versus clips for securing the cystic duct during LC. METHODS We identified eligible studies in PubMed, Medline, Cochrane Library, Embase, and SpringerLink up to 1st May 2018, together with the reference lists of original studies. Meta-analysis was conducted using STATA 14.0. Q-based chi-square test and the I statistics were utilized to assess heterogeneity among the included studies. A P-value below .05 was set for statistical significance. Forest plots of combined Hazard ratios (HRs) with 95% confidence intervals (CIs) were also generated. RESULTS Eight studies met eligibility criteria in this meta-analysis eventually. A total of 1131 patients were included, of whom 529 were contained in the US group, compared to 602 in the clips group, which showed a significant difference (P = .025) without substantial statistical heterogeneity (I = 0.0%). No statistical significance was revealed regarding age (I = 0.0%, P = .957), and sex (I = 0.0%, P = .578) between both groups. The operative time and hospital stay in the US group were significantly shorter than that in the clips group, with I = 95.0%, P = .000 and I = 72.8%, P = .005, respectively. Concerning conversion (I = 48.6%, P = .084), perforation (I = 12.0%, P = .338), along with bile leakage (I = 0.0% P = .594), and overall morbidity (I = 19.1%, P = .289), comparison between both groups exhibited no statistical significance. CONCLUSIONS US enabled shorter operative time and hospital stay during LC, compared with clips. Additionally, US was comparable to clips regarding conversion, perforation, along with bile leakage and overall morbidity. Therefore, our meta-analysis concluded that US is clinically superior to the conventional clips in some aspects, or is at least as safe and effective as them, concerning closure of the cystic duct and artery.
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16
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van Dijk AH, van Roessel S, de Reuver PR, Boerma D, Boermeester MA, Donkervoort SC. Systematic review of cystic duct closure techniques in relation to prevention of bile duct leakage after laparoscopic cholecystectomy. World J Gastrointest Surg 2018; 10:57-69. [PMID: 30283606 PMCID: PMC6162244 DOI: 10.4240/wjgs.v10.i6.57] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 08/18/2018] [Accepted: 08/28/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To study the effect of different techniques of cystic duct closure on bile leakage after laparoscopic cholecystectomy (LC) for biliary disease. METHODS A systematic search of MEDLINE, Cochrane and EMBASE was performed. Rate of cystic duct leakage (CDL) was the primary outcome. Risk of bias was evaluated. Odds ratios were analyzed for comparison of techniques and pooled event rates for non-comparative analyses. Pooled event rates were compared for each of included techniques. RESULTS Out of 1491 articles, 38 studies were included. A total of 47491 patients were included, of which 38683 (81.5%) underwent cystic duct closure with non-locking (metal) clips. All studies were of low-moderate methodological quality. Only two studies reported separate data on uncomplicated and complicated gallbladder disease. For overall CDL, an odds ratio of 0.4 (95%CI: 0.06-2.48) was found for harmonic energy vs clip closure and an odds ratio of 0.17 (95%CI: 0.03-0.93) for locking vs non-locking clips. Pooled CDL rate was around 1% for harmonic energy and metal clips, and 0% for locking clips and ligatures. CONCLUSION Based on available evidence it is not possible to either recommend or discourage any of the techniques for cystic duct closure during LC with respects to CDL, although data point out a slight preference for locking clips and ligatures vs other techniques. No separate recommendation can be made for complicated gallbladder disease.
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Affiliation(s)
- Aafke H van Dijk
- Departement of Surgery, Amsterdam University Medical Centre, Amsterdam 1105 AZ, The Netherlands
| | - Stijn van Roessel
- Departement of Surgery, Amsterdam University Medical Centre, Amsterdam 1105 AZ, The Netherlands
| | - Philip R de Reuver
- Department of Surgery, Radboud University Medical Center, Nijmegen 6525 GA, The Netherlands
| | - Djamila Boerma
- Department of Surgery, St. Antonius Hospital, Nieuwegein 3435 CM, The Netherlands
| | - Marja A Boermeester
- Departement of Surgery, Amsterdam University Medical Centre, Amsterdam 1105 AZ, The Netherlands
| | - Sandra C Donkervoort
- Department of Surgery, Onze Lieve Vrouw Gasthuis, Amsterdam 1091 AC, The Netherlands
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Liu GB, Mao YY, Yang CP, Cao JL. Sealing of the cystic and appendix arteries with monopolar electrocautery during laparoscopic combined cholecystectomy and appendectomy. Medicine (Baltimore) 2018; 97:e0206. [PMID: 29595660 PMCID: PMC5895399 DOI: 10.1097/md.0000000000010206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The best method to ligate the arteries during laparoscopic cholecystectomy or appendectomy remains controversy. The aim of this study is to introduce a new approach during laparoscopic combined cholecystectomy and appendectomy using a monopolar electrocautery to seal the cystic and appendix arteries. We retrospectively reviewed data from 57 patients who underwent laparoscopic combined cholecystectomy and appendectomy between December 2006 and June 2016. Each laparoscopic combined cholecystectomy and appendectomy was performed by coagulating and sealing the cystic and appendix arteries. Absorbable clip or coils were then used to ligate the proximal of cystic duct and the stump of appendix. The other side of the cystic duct and appendix which subsequently were to be removed from abdomen were used titanium clips or silk ligature. Of the 57 patients, 3 patients (5.3%) were converted to open surgery due to severe abdominal adhesions or gallbladder perforation. The mean operative time was 56 minutes (range, 40-80 minutes). Mean blood loss was 12 mL (range, 5-120 mL), and the mean postoperative hospital stay was 3.0 days (range, 2-5 days). No postoperative bleeding, biliary leakage, infection, or mortality occurred. Monopolar electrocautery to seal the cystic and appendix arteries is a safe, effective, and economical surgical procedure during laparoscopic combined cholecystectomy and appendectomy. Further randomized controlled clinical trials are required to validate our findings.
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Rajnish K, Sureshkumar S, Ali MS, Vijayakumar C, Sudharsanan S, Palanivel C. Harmonic Scalpel-Assisted Laparoscopic Cholecystectomy vs. Conventional Laparoscopic Cholecystectomy - A Non-randomized Control Trial. Cureus 2018; 10:e2084. [PMID: 29560297 PMCID: PMC5856421 DOI: 10.7759/cureus.2084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Introduction Laparoscopic cholecystectomy (LC) is the most commonly done, minimally invasive surgical procedure. Routinely used electrocautery produces more smoke, which masks the operating field, thereby prolongs the surgery and posing an increased risk of gallbladder (GB) perforation. The titanium clips used for clipping the cystic artery and cystic duct have a risk of slippage, which may lead to bleeding, and an increased risk for bile leakage. In addition, it may act as a nidus for stone formation. Advanced energy sources, such as the harmonic scalpel, though expensive, may provide the advantage of shorter operating time by reducing smoke, bloodless dissection in the GB bed, lower risk of bleeding from the cystic artery due to secure vessel sealing, and avoiding the use of a larger number of titanium clips. However, evidence to substantiate this advantage is limited. Aim To compare the operating time and perioperative complications between conventional laparoscopic cholecystectomy (CLC) and harmonic scalpel assisted laparoscopic cholecystectomy (HLC). Methodology All consecutive patients who underwent elective LC were included. Patients with acute infection, impaired liver function tests, concomitant common bile duct calculi, chronic liver disease/cirrhosis, suspected GB carcinoma, and pregnant women were excluded from the study. Patients were allocated into two groups. In the CLC group, both the cystic duct and the cystic artery were divided after conventional titanium clip application and electrocautery was used for thermal energy. In the HLC group, the cystic duct was clipped with a titanium clip and the rest of the procedure was carried out using Harmonic Ace (Ethicon, New Jersey, United States) and Harmonic Hook (Ethicon, New Jersey, United States). Outcome parameters analyzed were operating time in minutes, post-operative pain using visual analogue scale (VAS) scoring, frequency and route of analgesic requirement after 24 hours, and intraoperative complications, including bleeding, bile duct injury, GB perforation, and surgical site infection (SSI) in the postoperative period, per the Centers for Disease Control (CDC) criteria. Results Both the groups were comparable with respect to age, gender, body mass index (BMI), and the presence of comorbidity and an indication of cholecystectomy. The duration of surgery did not significantly differ between the groups (67.3 vs. 64.3 mins; p = 0.30). Other parameters, such as analgesic required on postoperative Day 1 (3.2 vs. 3; p = 0.67), VAS scores on Day 0 (4.55 vs. 4.65; p = 0.59), VAS scores on Day 1 (2.3 vs. 2.2; p = 0.84), superficial SSI (15% vs. 10%; p = 0.63), intraoperative GB perforation (30% vs. 20%; p = 0.71), and intraperitoneal drain (30% vs. 20%; p = 0.71) did not significantly differ between the groups. Conclusion HLC has no significant advantage over CLC with respect to operating time, postoperative pain, and perioperative complications.
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Affiliation(s)
- Kumar Rajnish
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Sathasivam Sureshkumar
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | | | - Chellappa Vijayakumar
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Sundaramurthi Sudharsanan
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Chinnakali Palanivel
- Preventive Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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Conrad C, Wakabayashi G, Asbun HJ, Dallemagne B, Demartines N, Diana M, Fuks D, Giménez ME, Goumard C, Kaneko H, Memeo R, Resende A, Scatton O, Schneck AS, Soubrane O, Tanabe M, van den Bos J, Weiss H, Yamamoto M, Marescaux J, Pessaux P. IRCAD recommendation on safe laparoscopic cholecystectomy. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2017; 24:603-615. [PMID: 29076265 DOI: 10.1002/jhbp.491] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
An expert recommendation conference was conducted to identify factors associated with adverse events during laparoscopic cholecystectomy (LC) with the goal of deriving expert recommendations for the reduction of biliary and vascular injury. Nineteen hepato-pancreato-biliary (HPB) surgeons from high-volume surgery centers in six countries comprised the Research Institute Against Cancer of the Digestive System (IRCAD) Recommendations Group. Systematic search of PubMed, Cochrane, and Embase was conducted. Using nominal group technique, structured group meetings were held to identify key items for safer LC. Consensus was achieved when 80% of respondents ranked an item as 1 or 2 (Likert scale 1-4). Seventy-one IRCAD HPB course participants assessed the expert recommendations which were compared to responses of 37 general surgery course participants. The IRCAD recommendations were structured in seven statements. The key topics included exposure of the operative field, appropriate use of energy device and establishment of the critical view of safety (CVS), systematic preoperative imaging, cholangiogram and alternative techniques, role of partial and dome-down (fundus-first) cholecystectomy. Highest consensus was achieved on the importance of the CVS as well as dome-down technique and partial cholecystectomy as alternative techniques. The put forward IRCAD recommendations may help to promote safe surgical practice of LC and initiate specific training to avoid adverse events.
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Hem-o-lok Clips Migration: An Easily Neglected Complication after Laparoscopic Biliary Surgery. Case Rep Surg 2017; 2017:7279129. [PMID: 29062580 PMCID: PMC5618746 DOI: 10.1155/2017/7279129] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 08/13/2017] [Indexed: 12/15/2022] Open
Abstract
Clip migration into the common bile duct (CBD) is a rare but well-established phenomenon of laparoscopic biliary surgery. The mechanism and exact incidence of clip migration are both poorly understood. Clip migration into the common bile duct can cause recurrent cholangitis and serve as a nidus for stone formation. We present a case, a 54-year-old woman, of clip-induced cholangitis resulting from surgical clip migration 12 months after laparoscopic cholecystectomy and laparoscopic common bile duct exploration (LC+LCBDE) with primary closure.
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21
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Minimally invasive resection of adrenal masses in infants and children: results of a European multi-center survey. Surg Endosc 2017; 31:4505-4512. [DOI: 10.1007/s00464-017-5506-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 03/08/2017] [Indexed: 12/14/2022]
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22
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Liao G, Wen S, Xie X, Wu Q. Harmonic Scalpel versus Monopolar Electrocauterization in Cholecystectomy. JSLS 2017; 20:JSLS.2016.00037. [PMID: 27547026 PMCID: PMC4978547 DOI: 10.4293/jsls.2016.00037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Laparoscopic cholecystectomy (LC) using surgical electrocautery is considered to be the gold standard procedure for the treatment of uncomplicated cholecystitis and cholelithiasis. The objective of the current study was to evaluate the effectiveness and safety of the Harmonic scalpel, an advanced laparoscopic technique associated with less thermal damage in LC, when compared to electrocautery. METHODS From October 2010 through June 2013, a total of 198 patients were randomly allocated to LC with a Harmonic scalpel (experimental group, 117 patients) or conventional monopolar electrocautery (control group, 81 patients). The main outcome measures were operative time, blood loss, conversion to laparotomy, postoperative hospital stay, post-LC pain, and cost effectiveness. RESULTS The 2 groups were comparable with respect to baseline patient characteristics. When compared to conventional monopolar electrocautery, there were no significant reductions in the operative time, bleeding, frequency of conversion to laparotomy, and duration of postoperative recovery with the Harmonic scalpel (P > .05 for all). CONCLUSIONS Laparoscopic cholecystectomy using conventional monopolar electrocautery is as effective and safe as that with the Harmonic scalpel, for treating uncomplicated cholecystitis and cholelithiasis.
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Affiliation(s)
- Guanqun Liao
- Department of General Surgery, Foshan Municipal Hospital, Southern Medical University, Foshan, China
| | - Shunqian Wen
- Department of General Surgery, Foshan Municipal Hospital, Southern Medical University, Foshan, China
| | - Xueyi Xie
- Department of General Surgery, Foshan Municipal Hospital, Southern Medical University, Foshan, China
| | - Qing Wu
- Department of General Surgery, Foshan Municipal Hospital, Southern Medical University, Foshan, China
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23
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Jiang HP, Liu YD, Li YS, Shen ZL, Ye YJ. Ultrasonic versus electrosurgical device for laparoscopic cholecystectomy: A systematic review with meta-analysis and trial sequential analysis. Int J Surg 2017; 40:24-32. [PMID: 28219818 DOI: 10.1016/j.ijsu.2017.02.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 01/10/2017] [Accepted: 02/15/2017] [Indexed: 01/30/2023]
Abstract
BACKGROUND Ultrasonic and electrosurgical energy dissectors are main dissecting devices widely used for the laparoscopic cholecystectomy. Trial sequential analyses can establish whether firm evidence favoring a specific device has been reached from accumulated literature. To explore this, we performed a meta-analysis and trial sequential analyses. METHODS PubMed, Embase, and the Cochrane Library were searched from inception to October 2016. The primary outcome was operative time. The secondary outcomes included adverse events during operation, postoperative complications, intra-abdominal collection, hospital stay, hospital costs, and sick leave or time to full recovery. Relative risks (RRs) were calculated for dichotomous outcomes and mean differences (MDs) for continuous outcomes. Finally, we calculated numbers needed to treat to examine benefits of the ultrasonic device. RESULTS We identified 19 studies. Compared with the electrosurgical device, the ultrasonic device led to shorter operative time (MD, -14.86; 95% confidence interval (CI), -21.45 to -8.27; P < 0.00001), less blood loss (MD, -47.24; 95% CI, -79.57 to -14.90; P = 0.004), fewer gallbladder perforations (RR, 0.45; 95% CI, 0.35 to 0.57; P < 0.00001), shorter hospital stay (MD, -0.37; 95% CI, -0.61 to -0.14; P = 0.002), and fewer abdominal pains (MD, -0.95; 95% CI, -1.40 to -0.50; P < 0.0001). The trial sequential analysis demonstrated that the cumulative z-curve crossed the trial sequential monitoring and reached the required information size of the operative time. The numbers needed to treat to avoid one gallbladder perforation and postoperative nausea, respectively, were 7 and 15. CONCLUSIONS Compared with the electrosurgery device, the ultrasonic device could be superior with more clinical effectiveness. The trial sequential analysis demonstrated that further studies about the operative time were not needed.
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Affiliation(s)
- Hong-Peng Jiang
- Department of Gastroenterological Surgery, Peking University People's Hospital, Beijing 100044, People's Republic of China
| | - Ya-Dong Liu
- Department of Urinary Surgery, The First Clinical Hospital, Harbin Medical University, Harbin 150001, People's Republic of China
| | - Yan-Sen Li
- Department of Gastroenterological Surgery, Peking University People's Hospital, Beijing 100044, People's Republic of China
| | - Zhan-Long Shen
- Department of Gastroenterological Surgery, Peking University People's Hospital, Beijing 100044, People's Republic of China.
| | - Ying-Jiang Ye
- Department of Gastroenterological Surgery, Peking University People's Hospital, Beijing 100044, People's Republic of China.
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Arbin L, Enlund M, Knutsson J. Post-tonsillectomy pain after using bipolar diathermy scissors or the harmonic scalpel: a randomised blinded study. Eur Arch Otorhinolaryngol 2017; 274:2281-2285. [PMID: 28213775 PMCID: PMC5383688 DOI: 10.1007/s00405-017-4451-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 01/03/2017] [Indexed: 01/17/2023]
Abstract
Objective To compare the postoperative pain following bipolar diathermy scissors tonsillectomy (higher temperature dissection) with harmonic scalpel tonsillectomy (lower temperature dissection). Methods Sixty patients aged 7–40 years planned for tonsillectomy with no other concurrent surgery were randomised to either bipolar diathermy scissors or harmonic scalpel as surgical technique. Blinded to the surgical technique, the patients recorded their pain scores (VAS, 0–10) at awakening and the worst pain level of the day in the postoperative period. All intake of pain medication was also recorded. Results No statistically significant differences were found between the two groups regarding postoperative pain levels or consumption of pain medication. Conclusion Usage of the harmonic scalpel does not render less postoperative pain following tonsillectomy when compared with usage of the bipolar diathermy scissors.
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Affiliation(s)
- Linn Arbin
- Dept of Otorhinolaryngology, Västerås Central Hospital, 721 89, Västerås, Sweden
| | - Mats Enlund
- Dept of Anaesthesiology, Västerås Central Hospital and Centre for Clinical Research, Uppsala University, County hospital, 721 89, Västerås, Sweden
| | - Johan Knutsson
- Dept of Otorhinolaryngology, Västerås Central Hospital and Centre for Clinical Research, Uppsala University, County hospital, 721 89, Västerås, Sweden.
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Kassem MI, Hassouna EM. Short-term outcome of total clipless laparoscopic cholecystectomy for complicated gallbladder stones in cirrhotic patients. ANZ J Surg 2017; 88:E152-E156. [PMID: 28118676 DOI: 10.1111/ans.13855] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 10/26/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND Cirrhotic patients have been known to be more affected with gallstones than their non-cirrhotic counterparts; since laparoscopy was introduced, it has been generally approved as the standard approach for cholecystectomies with the exception of end-stage cirrhosis. The purpose of this study was to evaluate the safety and efficacy of clipless laparoscopic cholecystectomy using the harmonic scalpel in complicated cholelithiasis in cirrhotic patients. METHODS This prospective study was conducted on 62 cirrhotic patients presenting to the Gastrointestinal Surgery Unit in Alexandria Main University Hospital with complicated gallstones between March 2013 and March 2016. Both intraoperative time and blood loss were calculated in addition to rates of conversion to open cholecystectomy, morbidity and mortality. RESULTS Most of our cases were females with a ratio of 1.7:1, with a mean age of 45.21 years, ranging from 25 to 65 years. The most common cause of cirrhotic liver was hepatitis C in 45.1% of patients. Among the 62 patients included in the study, 56 patients (90.3%) were presenting with acute cholecystitis and six patients were operated at the onset of acute biliary pancreatitis. The mean operative time was 72.9 min with mean blood loss 45.45 mL. CONCLUSION The study concluded safety of total clipless laparoscopic cholecystectomy using a harmonic scalpel in Child A and B type cirrhotic patients, who presented with complicated gallstones.
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Affiliation(s)
- Mohamed I Kassem
- Department of Surgery, Gastrointestinal Surgery Unit, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ehab M Hassouna
- Department of Internal Medicine, Hepatobiliary Unit, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Lopez-Delgado JC, Ballus J, Esteve F, Betancur-Zambrano NL, Corral-Velez V, Mañez R, Betbese AJ, Roncal JA, Javierre C. Outcomes of abdominal surgery in patients with liver cirrhosis. World J Gastroenterol 2016; 22:2657-2667. [PMID: 26973406 PMCID: PMC4777990 DOI: 10.3748/wjg.v22.i9.2657] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 10/30/2015] [Accepted: 12/14/2015] [Indexed: 02/06/2023] Open
Abstract
Patients suffering from liver cirrhosis (LC) frequently require non-hepatic abdominal surgery, even before liver transplantation. LC is an important risk factor itself for surgery, due to the higher than average associated morbidity and mortality. This high surgical risk occurs because of the pathophysiology of liver disease itself and to the presence of contributing factors, such as coagulopathy, poor nutritional status, adaptive immune dysfunction, cirrhotic cardiomyopathy, and renal and pulmonary dysfunction, which all lead to poor outcomes. Careful evaluation of these factors and the degree of liver disease can help to reduce the development of complications both during and after abdominal surgery. In the emergency setting, with the presence of decompensated LC, alcoholic hepatitis, severe/advanced LC, and significant extrahepatic organ dysfunction conservative management is preferred. A multidisciplinary, individualized, and specialized approach can improve outcomes; preoperative optimization after risk stratification and careful management are mandatory before surgery. Laparoscopic techniques can also improve outcomes. We review the impact of LC on surgical outcome in non-hepatic abdominal surgeries required in this cirrhotic population before, during, and after surgery.
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Aspinen S, Harju J, Kinnunen M, Juvonen P, Kokki H, Eskelinen M. A randomized multicenter study of minilaparotomy cholecystectomy versus laparoscopic cholecystectomy with ultrasonic dissection in both groups. Scand J Gastroenterol 2016; 51:354-9. [PMID: 26414236 DOI: 10.3109/00365521.2015.1091496] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Ultrasonic dissection (UsD) has been used in laparoscopic cholecystectomy (LC), though it is not the golden standard technique. Applying UsD to cholecystectomy by minilaparotomy (MC) is less common and there are no prospective randomized trials comparing these two techniques. Therefore, we conducted the present study to investigate the use of the UsD in the MC versus the LC procedure. MATERIAL AND METHODS Initially 104 patients with non-complicated symptomatic gallstone disease were randomized into MC (n = 53) or LC (n = 51) groups, both groups using UsD, over a period of 2 years (2013-2015). The study groups were similar in terms of age and American Society of Anesthesiologists (ASA) physical status score. RESULTS The demographic variables and the surgical data were similar in the study groups. Similar low postoperative pain scores were reported in the two study groups during the first four hours after surgery. The incidence of nausea/vomiting was similar between the two study groups, 47% in the MC group versus 42% in the LC group. However, the patients in the MC group were treated more frequently with antiemetics, the incidence being 39% in the MC group versus 21% in the LC group (p = 0.02). The pain at rest at 24h after the surgery was similar in the two study groups, but the LC patients reported less pain at the normal activity, the mean of numerical rating scale (NRS) of 0-10 score being 3.9 in the MC group versus 2.9 in the LC group (p = 0.05), and the pain at the quick movement/coughing, the mean NRS being 4.9 in the MC group versus 3.2 in the LC group (p = 0.005). The length of sick leave was 17.4 days in the MC group and 14.4 days in the LC group (p = 0.05). CONCLUSION Our results suggest that both MC and LC are feasible and safe options for mini-invasive cholecystectomy. A new finding with clinical relevance in the present work is a relatively similar short-term outcome in the MC and LC although the LC patients reported significantly lower pain score 24 hours postoperatively and a shorter convalescence.
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Affiliation(s)
- Samuli Aspinen
- a Department of Surgery , Kuopio University Hospital and School of Medicine, University of Eastern Finland , Kuopio , Finland
| | - Jukka Harju
- b Department of Surgery , Helsinki University Central Hospital , Helsinki , Finland
| | - Mari Kinnunen
- a Department of Surgery , Kuopio University Hospital and School of Medicine, University of Eastern Finland , Kuopio , Finland
| | - Petri Juvonen
- a Department of Surgery , Kuopio University Hospital and School of Medicine, University of Eastern Finland , Kuopio , Finland
| | - Hannu Kokki
- c Department of Anaesthesia and Operative Services , Kuopio University Hospital and School of Medicine, University of Eastern Finland , Kuopio , Finland
| | - Matti Eskelinen
- a Department of Surgery , Kuopio University Hospital and School of Medicine, University of Eastern Finland , Kuopio , Finland
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Ramos AC, Ramos MG, Galvão-Neto MDP, Marins J, Bastos ELDS, Zundel N. Total clipless cholecystectomy by means of harmonic sealing. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2016; 28:53-6. [PMID: 25861071 PMCID: PMC4739249 DOI: 10.1590/s0102-67202015000100014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 01/06/2015] [Indexed: 12/12/2022]
Abstract
Background In traditional laparoscopic cholecistectomy, the cystic duct and artery are
commonly closed by metallic clips just before their division. Although the
placement of these clips for occluding cystic artery and duct can be considered
safe, biliary leaks and bleeding may occur especially by its dislodgement. Aim To report a prospective case-series in total clipless cholecystectomy by means of
harmonic shears for closure and division of the artery and cystic duct as well
removal of the gallbladder from the liver. Methods Was evaluate a series of 125 patients who underwent laparoscopic cholecystectomy
where the sealing and division of cystic artery and duct was carried out only by
harmonic shears. The intact extracted gallbladder was submitted to a reverse
pressure test for assessment of the technique safety by means of CO2
insuflation. Results The most common indication for surgery was gallstones. The mean operative time was
26 min and all gallbladders were dissected intact from the liver bed. There was no
mortality and the overall morbidity rate was 0.8% with no hemorrhage or leaks. The
reverse pressure test showed that all specimens support at least 36-mmHg of
pressure without leaking. Conclusions The harmonic shears is effective and safe in laparoscopic cholecystectomy as a
sole instrument for sealing and division of the artery and cystic duct. The main
advantages could be related to the safety and decreased operative time.
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Sran H, Sebastian J, Hossain MA. Electrosurgical devices: are we closer to finding the ideal appliance? A critical review of current evidence for the use of electrosurgical devices in general surgery. Expert Rev Med Devices 2016; 13:203-15. [DOI: 10.1586/17434440.2016.1134312] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Abdallah E, Abd Ellatif M, El Awady S, Magdy A, Youssef M, Thabet W, Lotfy A, Elshobaky A, Morshed M. Is LigaSure a safe cystic duct sealer? An ex vivo study. Asian J Surg 2015; 38:187-90. [PMID: 25982449 DOI: 10.1016/j.asjsur.2015.03.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 02/09/2015] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND To compare the efficacy and safety of both mechanical methods (clips) and electrosurgical instruments, harmonic scalpel (HS) and LigaSure (LS), for securing the cystic duct during laparoscopic cholecystectomy (LC). METHODS During the study period from October 2010 to October 2012, 458 patients with gallbladder stones underwent LC. A total of 38 patients were excluded from the study for different reasons. The gallbladder was excised laparoscopically through the traditional method. The gallbladder specimens of the patients were divided into three equal groups randomly, and the distal part of the cystic duct was sealed ex vivo using ligaclips (Group A), HS (Group B), and LS (Group C). The gallbladders were then connected to a pneumatic tourniquet device and we very gradually increased the pressure with air. The bursting pressure of the cystic duct (CDBP) was measured and differences between the three groups were calculated. RESULTS The mean CDBP was 329.7 ± 38.8 mmHg in the ligaclip group, 358.0 ± 33.1 mmHg in the HS group, and 219.7 ± 41.2 mmHg in the LS group. A comparison of the mean CDBP between the groups indicated the superiority of HS over ligaclip and LS. CDBP was significantly higher in the ligaclips group compared with the LS group (p <0.001). HS and ligaclips were found to be safe sealers as their mean CDBP was found to be higher (>195 mmHg) than the maximum common bile duct pressure, whereas for LS the CDBP range was 150-297 mmHg, indicating that it is not safe for sealing. CONCLUSION HS is a safe alternative to clips. In fact, it was even safer than clips. By contrast, LS is not safe for cystic duct sealing.
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Affiliation(s)
- Emad Abdallah
- Department of General Surgery, Mansoura University Hospital, Mansoura, Egypt
| | - Mohamed Abd Ellatif
- Department of General Surgery, Mansoura University Hospital, Mansoura, Egypt.
| | - Saleh El Awady
- Department of General Surgery, Mansoura University Hospital, Mansoura, Egypt
| | - Alaa Magdy
- Department of General Surgery, Mansoura University Hospital, Mansoura, Egypt
| | - Mohamed Youssef
- Department of General Surgery, Mansoura University Hospital, Mansoura, Egypt
| | - Waleed Thabet
- Department of General Surgery, Mansoura University Hospital, Mansoura, Egypt
| | - Ahmed Lotfy
- Department of General Surgery, Mansoura University Hospital, Mansoura, Egypt
| | - Ayman Elshobaky
- Department of General Surgery, Mansoura University Hospital, Mansoura, Egypt
| | - Mosaad Morshed
- Department of General Surgery, Mansoura University Hospital, Mansoura, Egypt
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Single incision cholecystectomy using a clipless technique with LigaSure in a resource limited environment: The Bahamas experience. Int J Surg Case Rep 2015; 11:104-109. [PMID: 25958050 PMCID: PMC4446690 DOI: 10.1016/j.ijscr.2015.04.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 04/23/2015] [Accepted: 04/23/2015] [Indexed: 01/24/2023] Open
Abstract
SILC in the third world. The addition of LigaSure to enhance procedure. Look at feasibility. Look at cost different.
Background Scarless/single-incision laparoscopic cholecystectomy (SILC) is a new procedure. It affords a superior cosmetic outcome when compared to conventional laparoscopic cholecystectomy. We examine the application of this technique using LigaSure via a clipless method. The present study looks at the experience of a single surgeon using this method with initial evaluation of the safety, feasibility, affordability, and benefits of this procedure. Methods Twenty-eight patients underwent transumbilical SILC at Doctors Hospital from January to December, 2014. The cohort included both emergency and elective patients. There was no difference in the preoperative work-up as indicated. To perform the operation, a 2–2.5-cm linear incision was made through the umbilicus and the single port platform utilized. A 10 mm 30-degree laparoscope, a 5 mm LigaSure and straight instruments were used to perform the laparoscopic cholecystectomy procedure. Results All patients except two were operated on successfully. Conversion was considered the placement of an additional epigastric/Right upper quadrant (RUQ) port. The conversion rate to standard LC was 7%. No patient was converted to open cholecystectomy. In the 28 successfully completed patients, the median duration of the operation was 38.5 min and estimated operative blood loss was 24 ml. Patients were commenced on liquid diet immediately on being fully conscious and after return to the ward with an estimated time of 6 h. The mean postoperative hospital stay was 1.4 days. Follow-up visits were conducted for all patients at 2-weeks intervals and continued for 6 weeks after surgery where possible. Two patients developed wound infections. All patients were satisfied with the good cosmetic effect of the surgery. The total satisfaction rate was 100%. Conclusions SILC is a safe and feasible technique for operating with scarless outcomes and reducing perioperative discomfort at the same time. The GelPOINTTM is a safe and feasible platform to be used. The procedure can be accomplished using regular instruments and laparoscope. Curved instruments and a bariatric length laparoscope may make the procedure easier and result in greater time saving. The addition of LigaSure™ decreases the complexity of the operation, decreases operative time and blood loss. The technique is economical in a resource-limited environment.
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Yang CP, Cao JL, Yang RR, Guo HR, Li ZH, Guo HY, Shao YC, Liu GB. Efficacy of electrocoagulation in sealing the cystic artery and cystic duct occluded with only one absorbable clip during laparoscopic cholecystectomy. J Laparoendosc Adv Surg Tech A 2013; 24:72-6. [PMID: 24180354 DOI: 10.1089/lap.2013.0193] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Even though laparoscopic cholecystectomy (LC) emerged over 20 years ago, controversies persist with regard to the best method to ligate the cystic duct and artery. We proposed to assess the effectiveness and safety of electrocoagulation to seal the cystic artery and cystic duct after their occlusion with only one absorbable clip. MATERIALS AND METHODS We retrospectively compared the clinical data for 635 patients undergoing LC using electrocoagulation to seal the cystic artery and cystic duct that were occluded with only one absorbable clip (Group 1) and 728 patients undergoing LC using titanium clips (Group 2). In parallel, 30 rabbits randomized into six groups underwent cholecystectomy. After cystic duct ligation with absorbable or titanium clips, the animals were sacrificed 1, 3, or 6 months later, and intraabdominal adhesions were assessed after celiotomy. RESULTS The mean operative time was significantly shorter (41.6 versus 58.9 minutes, P<.01) in Group 1 than in Group 2. No cystic duct leaks occurred in any patients from Group 1, compared with seven leaks among the 728 (0.96%) patients from Group 2 (P<.05). The morbidity was significantly higher in Group 2 than in Group 1 (3.43% versus 1.58%). Mean intraoperative blood loss and hospitalization length were not significantly different between the two groups, and no deaths occurred in either group. In animal experiments, adhesion was tighter for absorbable than for titanium clips, but fibrous tissue encapsulation was thinner at the site of titanium clips. CONCLUSIONS Electrocoagulation of the cystic artery and cystic duct that were occluded with only one absorbable clip is safe and effective during LC. This approach is associated with shortened operative times and reduced leakage, compared with the standard method using metal clips.
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Affiliation(s)
- Chang-Ping Yang
- 1 Department of General Surgery, The 117th Hospital of the People's Liberation Army , Hangzhou, Zhejiang, China
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Harju J, Juvonen P, Kokki H, Remes V, Scheinin T, Eskelinen M. Minilaparotomy cholecystectomy with ultrasonic dissection versus conventional laparoscopic cholecystectomy: a randomized multicenter study. Scand J Gastroenterol 2013; 48:1317-23. [PMID: 23971855 DOI: 10.3109/00365521.2013.822545] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Cholecystectomy by minilaparotomy (MC) or by laparoscopy (LC) has been shown to have equal results of both early and late recovery. Although, the ultrasonic dissection (UsD) technique has seen used in LC, the technique is rarely used in MC. MATERIAL AND METHODS Initially, 88 patients with uncomplicated symptomatic gallstones were randomized into MC with UsD (n = 44) or conventional LC (n = 44) over a 2-year period (2010-2012). The two groups were similar in terms of age and American Society of Anesthesiologists (ASA) physical status score. Results. Both groups were similar in terms of the operative time and the time in the operation theatre, the success of day-surgery and satisfaction with the procedure. The MC group had significantly less postoperative pain than the LC group, p = 0.002, and the MC group used less analgesics doses during the first 24 h: 2.8 (1.2) doses vs. 3.8 (1.4) doses, p = 0.003. The convalescence needed was 3 days shorter in the MC group, 7 (3) days, than that in the LC-group, 10 (8) days, p = 0.024. In the MC group 4 patients and in the LC group 11 (p = 0.046) required more than 14 days of sick leave. In the MC group there was one and in the LC group two conversions to open surgery. CONCLUSION The patients in the MC group had less early postoperative pain and had a shorter convalescence than the patients in the LC group.
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Affiliation(s)
- Jukka Harju
- Department of Surgery, Helsinki University Central Hospital , Helsinki , Finland
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Suo G, Xu A. Clipless minilaparoscopic cholecystectomy: a study of 1,096 cases. J Laparoendosc Adv Surg Tech A 2013; 23:849-54. [PMID: 23980592 DOI: 10.1089/lap.2012.0561] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
PURPOSE Low conversion rate, high safety, and good cosmetic result with less medical cost are chased by all laparoscopic surgeons. We used general laparoscopic instruments and combined with absorbable thread trying to perform a clipless minilaparoscopic cholecystectomy for benign gallbladder patients and got all the above-mentioned results. SUBJECTS AND METHODS From January 2008 to February 2011, 1096 minilaparoscopic cholecystectomies were performed for patients with uncomplicated or complicated benign gallbladder disease by our treatment team. The three-port technique with the help of an electrocautery hook, forceps, and suction was applied for laparoscopy cholecystectomy, and the cystic duct and vessels were ligated by absorbable thread rather than hemostasis clips and Harmonic(®) scalpels (Ethicon, Cincinnati, OH). The operative time, blood loss, subhepatic drain, conversion rate, drainage time, and hospital stay were reviewed and statistically analyzed. RESULTS Our conversion rate was 0.18%, which was much lower than those reported by many studies. The mean operating time was 28 minutes (range, 11-70 minutes). Mean blood loss was 12 mL (range, 5-200 mL). A subhepatic drain was placed in 63 patients, with a mean drainage time of 1.7 days (range, 1-6 days). The mean postoperative hospital stay was 2.5 days (range, 2-7 days). No postoperative bleeding, biliary leakage, intraabdominal infection, umbilical site infection, umbilical incision herniation, biliary duct or bowel injury, or mortality occurred. CONCLUSIONS Minilaparoscopic cholecystectomy using absorbable thread instead of clips and Harmonic scalpels offers a safe, effective, and economical surgical alternative for benign gallbladder patients.
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Affiliation(s)
- Guangjun Suo
- Department of Digestive Surgery, East Hospital, Tongji University School of Medicine , Shanghai, People's Republic of China
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Common uses and cited complications of energy in surgery. Surg Endosc 2013; 27:3056-72. [PMID: 23609857 DOI: 10.1007/s00464-013-2823-9] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 11/05/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND Instruments that apply energy to cut, coagulate, and dissect tissue with minimal bleeding facilitate surgery. The improper use of energy devices may increase patient morbidity and mortality. The current article reviews various energy sources in terms of their common uses and safe practices. METHODS For the purpose of this review, a general search was conducted through NCBI, SpringerLink, and Google. Articles describing laparoscopic or minimally invasive surgeries using single or multiple energy sources are considered, as are articles comparing various commercial energy devices in laboratory settings. Keywords, such as laparoscopy, energy, laser, electrosurgery, monopolar, bipolar, harmonic, ultrasonic, cryosurgery, argon beam, laser, complications, and death were used in the search. RESULTS A review of the literature shows that the performance of the energy devices depends upon the type of procedure. There is no consensus as to which device is optimal for a given procedure. The technical skill level of the surgeon and the knowledge about the devices are both important factors in deciding safe outcomes. CONCLUSIONS As new energy devices enter the market increases, surgeons should be aware of their indicated use in laparoscopic, endoscopic, and open surgery.
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Mahabaleshwar V, Kaman L, Iqbal J, Singh R. Monopolar electrocautery versus ultrasonic dissection of the gallbladder from the gallbladder bed in laparoscopic cholecystectomy: a randomized controlled trial. Can J Surg 2012; 55:307-11. [PMID: 22854110 DOI: 10.1503/cjs.000411] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Ultrasonic dissection has been suggested as an alternative to monopolar electrocautery in laparoscopic cholecystectomy because it generates less tissue damage and may have a lower incidence of gallbladder perforation. We compared the 2 methods to determine the incidence of gallbladder perforation and its intraoperative consequences. METHODS We conducted a prospective randomized controlled trial between July 2008 and December 2009 involving adult patients with symptomatic gall stone disease who were eligible for laparoscopic cholecystectomy. Patients were randomly assigned before administration of anesthesia to electrocautery or ultrasonic dissection. Both groups were compared for incidence of gallbladder perforation during dissection, bile leak, stones spillage, lens cleaning, duration of surgery and estimation of risk of gallbladder in the presence of complicating factors. RESULTS We included 60 adult patients in our study. The groups were comparable with respect to demographic characteristics, symptomatology, comorbidities, previous abdominal surgeries, preoperative ultrasonography findings and intraoperative complications. The overall incidence of gallbladder perforation was 28.3% (40.0% in the electrocautery v. 16.7% in the ultrasonic dissection group, p = 0.045). Bile leak occurred in 40.0% of patients in the electrocautery group and 16.7% of patients in ultrasonic group (p = 0.045). Lens cleaning time (p = 0.015) and duration of surgery (p = 0.001) were longer in the electrocautery than the ultrasonic dissection group. There was no statistical difference in stone spillage between the groups (p = 0.62). CONCLUSION Ultrasonic dissection is safe and effective, and it improves the operative course of laparoscopic cholecystectomy by reducing the incidence of gallbladder perforation.
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Affiliation(s)
- Varun Mahabaleshwar
- The Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Xiong J, Altaf K, Huang W, Javed MA, Mukherjee R, Mai G, Hu W, Sutton R, Liu X. A meta-analysis of randomized clinical trials that compared ultrasonic energy and monopolar electrosurgical energy in laparoscopic cholecystectomy. J Laparoendosc Adv Surg Tech A 2012; 22:768-77. [PMID: 22967036 DOI: 10.1089/lap.2012.0157] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Currently, monopolar electrical energy is still widely used as the main source of energy for laparoscopic cholecystectomy (LC). However, some studies have suggested that the use of ultrasonic energy is more advantageous. This meta-analysis pooled the currently published randomized controlled trials comparing the safety and efficacy of ultrasonic energy and monopolar electrical energy in LC. MATERIALS AND METHODS MEDLINE, EMBASE, Science Citation Index Expanded, and the Cochrane Central Register of Controlled Trials for relevant articles published between January 1985 to February 2012 by using the search terms "laparoscopic cholecystectomy," "electrocoagulation," "electrosurgery," "ultrasonics," "ultrasonic therapy," and "dissection." Intraoperative and postoperative measures and complications were evaluated. RESULTS Eight high-quality randomized controlled trials with 1056 patients were included. Differences in mean operation time, mean blood loss, mean hospital stay, gallbladder perforation, and postoperative abdominal pain score at 24 hours were statistically significant between the two groups, in favor of the use of ultrasonic energy. However, there were no differences in operation conversion, bile leakage, intra-abdominal collections, and postoperative nausea at 24 hours. CONCLUSIONS Ultrasonic energy is as safe and effective as electrosurgical energy and potentially might be safer in LC. However, the financial implications of this technical modality need to be established in cost-effectiveness analysis.
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Affiliation(s)
- Junjie Xiong
- Department of Hepato-Biliary-Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, China
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Is Monopolar Electrocautery Safe and Effective for Control of the Cystic Artery During Laparoscopic Cholecystectomy? J Laparoendosc Adv Surg Tech A 2012; 22:557-60. [DOI: 10.1089/lap.2011.0507] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Ostapoff KT, Euhus D, Xie XJ, Rao M, Moldrem A, Rao R. Axillary lymph node dissection for breast cancer utilizing Harmonic Focus®. World J Surg Oncol 2011; 9:90. [PMID: 21843361 PMCID: PMC3170616 DOI: 10.1186/1477-7819-9-90] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Accepted: 08/15/2011] [Indexed: 12/28/2022] Open
Abstract
Background For patients with axillary lymph node metastases from breast cancer, performance of a complete axillary lymph node dissection (ALND) is the standard approach. Due to the rich lymphatic network in the axilla, it is necessary to carefully dissect and identify all lymphatic channels. Traditionally, these lymphatics are sealed with titanium clips or individually sutured. Recently, the Harmonic Focus®, a hand-held ultrasonic dissector, allows lymphatics to be sealed without the utilization of clips or ties. We hypothesize that ALND performed with the Harmonic Focus® will decrease operative time and reduce post-operative complications. Methods Retrospective review identified all patients who underwent ALND at a teaching hospital between January of 2005 and December of 2009. Patient demographics, presenting pathology, treatment course, operative time, days to drain removal, and surgical complications were recorded. Comparisons were made to a selected control group of patients who underwent similar surgical procedures along with an ALND performed utilizing hemostatic clips and electrocautery. A total of 41 patients were included in this study. Results Operative time was not improved with the use of ultrasonic dissection, however, there was a decrease in the total number of days that closed suction drainage was required, although this was not statistically significant. Complication rates were similar between the two groups. Conclusion In this case-matched retrospective review, there were fewer required days of closed suction drainage when ALND was performed with ultrasonic dissection versus clips and electrocautery.
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Affiliation(s)
- Katherine T Ostapoff
- Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9155, USA.
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Ogawa T, Hattori R, Yamamoto T, Gotoh M. Safe use of ultrasonically activated devices based on current studies. Expert Rev Med Devices 2011; 8:319-24. [PMID: 21542705 DOI: 10.1586/erd.11.3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Ultrasonically activated devices (USADs) are a widely used alternative to suture ligation and clips in open and laparoscopic surgery because of their fast and easy control of bleeding without significant complications. By inducing protein denaturation and forming coaptive coagulation to seal vessels for cutting tissue, USADs result in reduced operating time, blood loss and hospital stay. Recently, various other types of vessel sealers have become available. In this article, we summarize the mechanism, efficacy and the advantages and disadvantages of USADs for appropriate use in surgery.
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Affiliation(s)
- Teruyuki Ogawa
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Feroci F, Lenzi E, Kröning KC, Scatizzi M. A single-institution review of the absorbable clips used in laparoscopic colorectal and gallbladder surgery: feasibility, safety, and effectiveness. Updates Surg 2011; 63:103-7. [PMID: 21394536 DOI: 10.1007/s13304-011-0059-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2011] [Accepted: 02/25/2011] [Indexed: 11/25/2022]
Abstract
This retrospective study was conducted to examine the safety and effectiveness of polymeric absorbable clips in laparoscopic gallbladder and colorectal surgery. The prospectively maintained database review included all patients undergoing elective laparoscopic cholecystectomy and colorectal resection at the institution between November 2004 and December 2009. In each patient, absorbable clips were used as the only system of vascular and cystic duct ligation. Of the 911 patients who satisfied the inclusion criteria, 664 underwent laparoscopic cholecystectomy and 247 underwent laparoscopic colonic resection. No intra-operative or post-operative bleeding related to absorbable clip use occurred in either procedure. No bile duct injuries or cystic duct leakages were observed. There were no peri-operative deaths with either procedure. In this experience, absorbable clips demonstrated easy handling and high reliability. They provided safe hemostasis and permitted complete and adequate oncologic resection.
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Affiliation(s)
- Francesco Feroci
- Department of General Surgery, Misericordia and Dolce Hospital, Piazza dell'Ospedale 5, 59100 Prato, Po, Italy.
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Jain SK, Tanwar R, Kaza RCM, Agarwal PN. A prospective, randomized study of comparison of clipless cholecystectomy with conventional laparoscopic cholecystectomy. J Laparoendosc Adv Surg Tech A 2011; 21:203-8. [PMID: 21375416 DOI: 10.1089/lap.2010.0455] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Laparoscopic cholecystectomy has become a gold standard in the treatment of symptomatic gallstone disease. Amalgamation with upcoming technology makes the present-day procedure faster and safer. Ultrasonic shears, which perform dissection and ligation by cavitation and coaptation of vessels, are the latest addition to the armamentarium of laparoscopic surgeons. Acceptance of its safety and efficacy awaits its use as the sole instrument in the widely accepted procedure. METHODS A prospective, randomized control trial was conducted in 200 patients with symptomatic gallstone disease, who were randomly divided into two comparable groups, one undergoing cholecystectomy using ultrasonically activated shears and the other using conventional clip and electrocautery. Various parameters such as duration of surgery, removal of gallbladder, blood loss, postoperative pain scores, analgesic requirement, duration of stay, and complications were compared between the two groups. RESULTS Patients who underwent laparoscopic cholecystectomy using ultrasonic shears had a faster surgery (64.7 versus 50 minutes; P < .002) and removal of gallbladder from gallbladder bed (3.94 versus 7.46 minutes; P < .001) with less blood loss and pain scores (1.86 versus 3.01; P < .002). They had a shorter duration of hospital stay (1.89 versus 2.52 days; P < .001) and decreased risk of gallbladder perforation (9 versus 18; P < .005). The analgesic requirement was also less on the first postoperative day. There was no incidence of any major complication or bile leak during a 6-month follow-up period in either of the groups. CONCLUSION Ultrasonically activated scalpel can be used safely in laparoscopic cholecystectomy without risk of major injuries or leaks. It fairs better than electrocautery in terms of faster and safer surgery with decreased associated morbidity, less pain, and early return back home.
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Affiliation(s)
- Sudhir Kumar Jain
- Department of Surgery, Maulana Azad Medical College, New Delhi, India.
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Kavlakoglu B, Pekcici R, Oral S. Verification of clipless closure of cystic duct by harmonic scalpel. J Laparoendosc Adv Surg Tech A 2011; 20:591-5. [PMID: 20822415 DOI: 10.1089/lap.2010.0222] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION The excellent results of harmonic scalpel (HS) for closure of blood vessels encouraged surgeons to use these instruments for cystic ducts. The use of HS on tissues other than blood vessels was started with little data about its efficacy or safety. Therefore, this study was designed to verify the safety and efficacy of HS for achieving safe closure of the cystic ducts after laparoscopic cholecystectomy. MATERIALS AND METHODS Sixty patients with symptomatic gallstone disease were enrolled in this prospective case control study. The patients were operated with laparoscopic technic and divided into two groups (n = 30). After the dissection of Calot's triangle, proximal cystic ducts on common bile ducts were sealed with single surgical clips (SC) in both groups. In the first group, distal of the cystic ducts was sealed with single SC and the gallbladders were removed with SC. In the second group, distal of the cystic ducts was sealed with HS and the gallbladders were removed as sealed cystic ducts with HS. Twenty-gauge catheters were inserted into the fundus of gallbladders in vitro and connected to the arterial line transducer set. A gradually increasing pressure was applied through a sphygmomanometer. The bursting pressures of the gallbladders were measured, and differences between HS and single SC groups were calculated with independent samples t-test. The value of P < 0.05 was accepted as significant. RESULTS The mean cystic duct bursting pressures in single SC and HS groups were 332.46 +/- 4.62 and 343.06 +/-4.28 mmHg, respectively. The mean values between the groups were found significant and indicated the superior results of HS. CONCLUSIONS HS sealer could be an alternative method for cystic duct closure, especially for avoiding the clip displacement and migration of the clip. Results of this study indicated that HS sealer was as reliable as single SC and it could be accepted as a standard closure technic.
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Affiliation(s)
- Burak Kavlakoglu
- Ministry of Health Ankara Oncology Training and Research Hospital , Ankara, Turkey
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Hope WW, Padma S, Newcomb WL, Schmelzer TM, Heath JJ, Lincourt AE, Heniford BT, Norton HJ, Martinie JB, Iannitti DA. An evaluation of electrosurgical vessel-sealing devices in biliary tract surgery in a porcine model. HPB (Oxford) 2010; 12:703-8. [PMID: 21083796 PMCID: PMC3003481 DOI: 10.1111/j.1477-2574.2010.00240.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate two electrosurgical vessel-sealing devices in biliary surgery. METHODS Porcine common bile ducts (CBDs) were sealed with two electrosurgical devices, an electrothermal bipolar vessel-sealing device (EBVS) and ultrasonic coagulation shears. Acute study animals underwent surgical bile duct sealing followed by immediate burst pressure testing. Chronic study animals were maintained for 1 week postoperatively and then tested. RESULTS The seal failure rate in the acute study was 50% for both the EBVS device and shears, and 0% for the laparoscopic surgical clip device used as a control. The latter had significantly higher burst pressures (646.2 ± 281.8 mmHg; P = 0.006) than the EBVS device (97.6 ± 86.6 mmHg) and shears (71.7 ± 89.3 mmHg). No significant difference in burst pressures was noted between the EBVS device and shears (97.6 ± 86.6 mmHg vs. 71.7 ± 89.3 mmHg). In the chronic study, obvious bile leaks occurred in one of four pigs (25%) in the EBVS device subgroup and two of four pigs (50%) in the shears subgroup. The average proximal CBD pressure in seven pigs was 16.1 ± 4.1 mmHg. The average chronic burst pressure in the control subgroup was 1088.0 ± 922.6 mmHg. CONCLUSIONS Given the high rates of failure of the EBVS device and the shears in consistently sealing biliary ducts, we do not recommend their routine use in biliary surgery.
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Affiliation(s)
- William W Hope
- Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical CenterCharlotte, NC, USA
| | - Srikanth Padma
- Section of Hepato-Pancreatico-Biliary Surgery, Carolinas Medical CenterCharlotte, NC, USA
| | - William L Newcomb
- Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical CenterCharlotte, NC, USA
| | | | - Jessica J Heath
- Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical CenterCharlotte, NC, USA
| | - Amy E Lincourt
- Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical CenterCharlotte, NC, USA
| | - B Todd Heniford
- Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical CenterCharlotte, NC, USA
| | - H James Norton
- Department of Biostatistics, Carolinas Medical CenterCharlotte, NC, USA
| | - John B Martinie
- Section of Hepato-Pancreatico-Biliary Surgery, Carolinas Medical CenterCharlotte, NC, USA
| | - David A Iannitti
- Section of Hepato-Pancreatico-Biliary Surgery, Carolinas Medical CenterCharlotte, NC, USA
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Turial S, Engel V, Sultan T, Schier F. Closure of the Cystic Duct During Laparoscopic Cholecystectomy in Children Using the LigaSure Vessel Sealing System. World J Surg 2010; 35:212-6. [DOI: 10.1007/s00268-010-0813-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Rubino LJ, Konstantakos EK, Stills HF, Dudley ES, Grunden BK, Malaviya P. Healing of Iatrogenic Skeletal Muscle Wounds Is Affected by Incision Device. Surg Innov 2010; 17:85-91. [PMID: 20504782 DOI: 10.1177/1553350610364531] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Orthopedic joint procedures frequently require extensive dissection of skeletal muscles resulting in tissue injury, formation of scar tissue, pain, and potentially, functional impairment. The authors hypothesized that using a low-temperature ultrasonic cutting and coagulating device (Harmonic Blade, Ethicon Endo-Surgery, Cincinnati, OH) would result in reduction in tissue trauma in terms of reducing acute and chronic inflammation during healing. Bilateral longitudinal incisions were made into the tibialis cranialis muscles of rabbits with either a Harmonic Blade or a standard monopolar electrosurgical scalpel. At 3, 7, and 21 days postoperatively, necropsy and histological evaluations indicated a significant attenuation of acute inflammation ( P = .011) for the Harmonic incisions compared with electrosurgery. No significant differences were observed for chronic inflammation, necrosis, or fibrosis. Use of a Harmonic scalpel during dissection of skeletal muscle in orthopedic surgery may result in reduced influx of neutrophils, reducing acute inflammation, and potentially aid in reducing postoperative pain and functional impairment.
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El Nakeeb A, Askar W, El Lithy R, Farid M. Clipless laparoscopic cholecystectomy using the Harmonic scalpel for cirrhotic patients: a prospective randomized study. Surg Endosc 2010; 24:2536-41. [PMID: 20376490 DOI: 10.1007/s00464-010-0999-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Accepted: 02/27/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND Improved laparoscopic experiences have made laparoscopic cholecystectomy (LC) feasible options for cirrhotic patients. This study aimed to compare the traditional method for LC with LC using the Harmonic scalpel in terms of safety and efficacy for cirrhotic patients. METHODS In this study, group A (60 patients) underwent LC by the traditional method (TM) with clipping of both the cystic duct and artery and dissection of the gallbladder by diathermy, and group B (60 patients) had LC performed using Harmonic scalpel (HS) closure and division of both the cystic duct and artery with dissection of the gallbladder by the HS. The perioperative data were recorded. RESULTS The operation with the Harmonic scalpel was performed in less time than TM (45.17 ± 10.54 vs. 69.71 ± 13.01 min; p = 0.0001). The intraoperative blood loss was significantly more with TM (133 ± 131.13 l vs. 70.13 ± 80.79 ml; p = 0.002). The conversion rate was 5% with TM and 3.3% with HS (p = 0.65). The incidence of gallbladder peroration was lower in the HS group (10% vs. 18.3%; p = 0.03). Bile leak was encountered in 1.7% with HS and 3.3% with TM (p = 0.45). The visual analog scale (VAS) for pain with HS on postoperative day 1 was (3.07 ± 2.02 vs. 4.4 ± 2.11 (p = 0.001). CONCLUSION For cirrhotic patients, LC still is more complicated and difficult than for patients without cirrhosis. The Harmonic scalpel provides complete hemobiliary stasis and is a safe alternative to the standard clipping of the cystic duct and artery for cirrhotic patients. It offers a shorter operative duration and less blood loss.
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Affiliation(s)
- Ayman El Nakeeb
- Department of General Surgery, Mansoura University, Mansoura, Egypt.
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