Laparoscopic cholecystectomy using harmonic: not only clipless

Background: Laparoscopic cholecystectomy is the gold standard treatment of gallstones. The ultrasonically acti- vated scalpel (Harmonic scalpel, Ethicon) may be used as the sole instrument for both gallbladder dissection and section of the cystic artery and duct with no need of further ligatures. Methods: In a series of 40 consecutive patients, laparo- scopic cholecystectomy was performed with the Harmonic scalpel. In 8 patients, an additional cystic duct ligature with clips was performed because of the large size of the duct (5 cases of associated common bile duct stones, 1 of acute cholecystitis, and 2 of gallbladder empyema). There were 31 females and 9 males. Indications were 27 sim- ple gallstones, associated in 5 cases with common bile duct stones; 12 acute cases of cholecystitis; and 2 cases of gallbladder empyema. Associated procedures were performed in 11 cases. Results: The mean operative time was 62 minutes. Intraop- erative cholangiography was performed in 5 cases and common bile duct exploration in 3. A drain was left in 17 patients. No conversions were necessary. No patients developed postoperative complications, and the mean postoperative hospital stay was 2.1 days. Conclusions: Laparoscopic cholecystectomy performed with an ultrasonically activated scalpel is feasible and effective. The advantages are represented by using a unique instrument both for dissection of the gallbladder and division of the artery and duct. Furthermore, because of the minimal thermal dispersion, the use of the Harmonic scalpel reduces the risk of injuries. The main limit of the procedure is represented by the cystic duct size: if more than 5mm in diameter an additional ligature is necessary