A COMPARATIVE ANALYSIS BETWEEN ELECTROSURGICAL VERSUS HARMONIC DISSECTION OF GALL BLADDER FROM ITS BED IN LAPAROSCOPIC CHOLECYSTECTOMY

Background: Various energy sources are now available like electrosurgical (monopolar and bipolar), ultrasonic shear devices, ultrasonic with bipolar and hydro dissection to separate gall bladder from liver bed. We conducted a study to compare electrosurgical and ultrasonic devices in dissection of gall bladder

Method: A prospective randomized controlled study was conducted involving 100 patients with gallstone disease. Patients were divided into two groups by the process of closed envelope randomization into electrosurgery (Group A) or ultrasonic dissection(Group B) groups. Both groups were compared for ease and feasibility of procedure, intra-operative complications during the procedure, operative time, conversion of laparoscopic to open cholecystectomy, post operative complication, comparison of pain, duration of stay in hospital and cost factor.

Observation: Various parameters were compared and it was observed that intraoperative bleeding was more in (28%) in the electrosurgery group in comparison to the harmonic group (8%). Injury to liver parenchyma was noticed less in the harmonic group (2%). Gall bladder perforation and bile leak were recorded more in electrosurgery patients (24%). Spillage of stone was 16% and 4% in Groups A and B respectively. Gut injury was observed in 2% of Group A in comparison to 0% in Group B. No CBD injury and postoperative complications were observed in either group. Post-operative hospital stay was lesser in Group B (1.980.51days) than in Group A (2.24=0.66 days). Postoperative pain was more in the electrosurgery group.

Conclusion: Dissection with harmonic scalpel in laparoscopic cholecystectomy is safe and technically feasible and may further improve surgical outcomes in terms of reduced duration of postoperative stay in hospital and pain with a significant reduction in intraoperative complications.