Published: 2017-11-25

Harmonic scalpel versus titanium clips and l-hook in the ligation of cystic duct and artery and gall bladder dissection in laparoscopic cholecystectomy

Anand Vijayvargiya, S. K. Jain, Varsha Soni


Background: Laparoscopic cholecystectomy is a gold standard for gall bladder stone surgery. The Aim and objective of study was to compare the total duration of surgery, intraoperative complication like bile leak from cystic duct stump, spillage of bile from gallbladder and post op pain and abdomen distension and jaundice.

Methods: Study was carried out in dept. of gen Surgery, Govt medical college Kota in yr. 2015-16 in a total of 50 patients with cholelithiasis with cholecystitis. Patient were equally divided randomly into two groups (a) Harmonic scalpel group and (b) Titanium Clip and L hook group. All patients with medical comorbidities, Concomitant CBD calculi, cirrhosis and portal HT were excluded from study. Intraoperatively adhesions, bile spillage from GB and cystic duct stump noted Postoperatively complain like pain abdomen, Jaundice, and fever were noted. Duration of hospital stay was observed. All results were statistically analyzed using Chi square and ANOVA test.

Results: Both groups were comparable on the basis of age and sex distribution, as no statistically difference was noted (P value 0.867 and 0.999 respectively). Intraoperative findings were adhesions 5 in clip group and 7 in harmonic group. Spillage from gall bladder was 2 in Clip group and 3 in harmonic group. Mean duration of surgery was 65.20 min in clip group and 63.68 in harmonic group with no statistically significant difference in both the group (P Value 0.727). Average duration of hospital stay was similar in both the groups with a mean of 2.6 days. Postoperative complication was fever, abdomen pain and distension were 3,1,1 were respectively in the clip group and 3,2,2 respectively in harmonic group with the P value of 0.999 which was statistically insignificant. No CBD injury was noted in any case. Conversion to open cholecystectomy was not done in any case. On 1week and 1 month follow up 2 cases in clip group and 1 in HS group had collection in gall bladder fossa and none at I month.

Conclusions: Harmonic scalpel offers an effective, alternative and safe method to cystic duct division and Gallbladder dissection from liver bed.


Clips. L hook, Harmonic scalpel, Laparoscopic cholecystectomy

Full Text:



Hanazaki K, Igarashi J, Sodeyama H, Matsuda Y. Bile leakage resulting from clip displacement of the cystic duct stump. Surg Endoscop. 1999;13(2):168-71.

Nelson TM, Masanobu MD, Mulvihill SJ. MD:“How Secure Are Laproscopically Placed Clips. An In Vitro and In Vivo Study". Arch Surg. 1992;127:718-20.

Ammann K, Kiesenebner J, Gadenstätter M, Mathis G, Stoss F. Embolism of a metallic clip: an unusual complication following laparoscopic cholecystectomy. Digestive Surg. 2000;17(5):542-4.

Chong VH. Iatrogenic biliary stone. Surgic Technol Internat. 2005;14:147-55.

Geissler B, Lindemann F, Hausser L, Witte J. Dislocation of clips of the cystic duct stump. Zentralblatt fur Chirurgie. 1998;123:102-5.

Khan JS, Hassan H, Iqbal M. laparoscopic cholecystectomy at rawalpindi general hospital a clinical practice audit. Pak Armed Forces Med J. 2010;60(4):553-6.

Westervelt J. Clipless cholecystectomy: broadening the role of the harmonic scalpel JSLS. 2004;8(3):283-5.

Bessa SS, Al-Fayoumi TA, Katri KM, Awad AT. Clipless laparoscopic cholecystectomy by ultrasonic dissection. J Lapa Adv Surg Tech. 2008;18(4):593-8.

Fathy O, Zeid MA, Abdallah T, Fouad A, Eleinien AA, El-Hak NG, Eleibiedy G, El-Wahab MA, Sultan A, Anwar N, Ezzat F. Laparoscopic cholecystectomy: a report on 2000 cases. Hepato-gastroenterol. 2003;50(52):967-71.

Marakis GN,Pavlidis TE, Ballas K, Aimoniotou E Psarras K, Karvounaris D.Major Complications during Laparoscopic Cholecystectomy. Int Surg. 2007;92:142-6.

Tsimoyiannis EC, Jabarin M, Glantzounis G, Lekkas ET, Siakas P, Stefanaki-Nikou S. Laparoscopic cholecystectomy using ultrasonically activated coagulating shears. Surgical Laparoscopy Endoscopy and Percutaneous Techniques. 1998;8(6):421-4.

Hüscher CG, Lirici MM, Anastasi A, Sansonetti A, Amini M. Laparoscopic cholecystectomy by harmonic dissection. Surgical endoscopy. 1999;13(12):1256-7.

Amarin NS. Harmonic scalpel and clipless cholecystectomy. Wo J Laparoscopic Surg. 2008;1(2):6-8.