COMPARATIVE STUDY BETWEEN LAPAROSCOPIC CHOLECYSTECTOMY BY ULTRASONIC SCALPEL VERSUS CONVENTIONAL METHOD: A PROSPECTIVE RANDOMIZED STUDY

Dr. Mohammed Najm Mohammed Tameemi, Safauldeen Salim

Abstract


Introduction
The ultrasonically activated scalpel has proven to be an effective, efficient, and safe instrument for dissection and haemostasis in both open and laparoscopic surgical procedures. This ultrasonic scalpel work on the tissue’s cutting and coagulating very effectively with the replacement of high frequency current, which connected with diverse complications. The principle is transforming of the electric power into mechanical movement of the working part of the instrument, by piezoelectrical transducer situated in the hand piece. The primary use of the ultrasonic scalpel in laparoscopic cholecystectomies has been for the division of the cystic artery and gallbladder bed dissection.

Aim of the study
Aim of this study is a comparison between the use of ultrasonic scalpel and conventional electrocautery in laparoscopic cholecystectomy, as a regard of safety and efficacy.

Patients and methods
A Prospective study done for (428) patients underwent laparoscopic cholecystectomy. (254) performed by using conventional electrocautery and (174) using ultrasonic scalpel (LOTUS). From January 2010 to November 2010 in Al-Sader Teaching Hospital, and Al-Gadeer Private Hospitals in Najaf city, different surgeons operated all these patients.

Result
Four hundred and twenty eight patients underwent laparoscopic cholecystectomy, with regarding to intraoperative bleeding the results (16.5% vs. 2.3%), and to gallbladder perforation (10.5% vs. 8%), and to need for drain (90.5% vs. 3.4), and to the need for proximal clipping of cystic artery (90.5% vs. 63.2%).

Conclusion
The application of ultrasonic energy to endoscopic surgery makes procedures safer, easier, and efficient dissection and haemostasis.


Keywords


Laparoscopic cholecystectomy, ultrasonic scalpel (LOTUS), conventional electrocautery.

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