COMPARISON BETWEEN HARMONIC ACE VERSUS CONVENTIONAL MONOPOLAR DIATHERMY IN LAPAROSCOPIC CHOLECYSTECTOMY IN TERMS OF GALLBLADDER PERFORATION

Abstract

Objective: To compare Harmonic scalpel with conventional Monopolar Electrocautery hook in terms of gallbladder perforation rate in Laparoscopic Cholecystectomy.

Study design: Randomized controlled trial.

Place and Duration of Study: Department of Surgery Combined Military Hospital (CMH) Rawalpindi, Pakistan, from Feb 2013 to Oct 2013.

Methodology: Consecutive 280 patients of cholelithiasis, fulfilling inclusion criteria, were included in this study after taking written informed consent and approval from hospital ethical committee. They were divided into two equal groups of 140 patients i.e. “Group A” who underwent LC by Harmonic scalpel and “Group B” in which conventional Monopolar electrocautery was used for dissection of gallbladder.

Results: An increased incidence of 21.42% gallbladder perforation (GBP) in laparoscopic cholecystectomy (LC), was observed in “Group B” using Monopolar electrocautery for dissection as compared to 8.57% in “Group A” using Harmonic scalpel (p=0.002). Male gender was significantly associated with increased GBP i.e. 33.33% as compared to females 12.29% irrespective of the instrument used.

Conclusion: Harmonic scalpel is better alternative to traditional Monopolar Electrocautery in LC due to decrease incidence of GBP.