Comparative Study of single clip (SCLC), two clip (TCLC) and clipless cholecystectomy(CLLC) using harmonic ace versus conventional laparoscopic cholecystectomy (CLC).
EAES Academy. DEVKARAN B. 07/05/22; 363041; P085
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Abstract:
Introduction: Gallstones are a common digestive disorder that constitutes a significant health problem. The incidence of cholelithiasis varies greatly and Laparoscopic cholecystectomy has been accepted as the “gold standard” for the treatment of symptomatic gallstone disease. Advanced energy source mainly harmonic scalpel, provide the advantage of shorter operating time by reducing smoke, bloodless dissection in calot’s triangle, lower risk of bleeding from cystic artery due to secure vessel sealing and reducing use of large number of titanium clips. Conventionally 6 titanium clips are used for laparoscopic cholecystectomy, 3 for cystic duct and 3 for cystic artery before division. The cost for using 6 titanium clips are high, therefore by using lesser number of titanium clips we aimed at reducing overall cost as well as time used in laparoscopic cholecystectomy. In addition, various studies have reported that clips have been associated with complications in form of migration.
We compared the advantages of single clip laparoscopic cholecystectomy (SCLC), two clips laparoscopic cholecystectomy (TCLC) and clipless laparoscopic cholecystectomy (CLLC) using single vikryl suture using harmonic ace with conventional laparoscopic cholecystectomy (CLC) using 6 clips and standard electrocautery.
Material and Methods: This study included 200 patients of proven gallstones over a period of 1 year. Patients were randomly divided into four groups with each group consisting of 50 patients. Group 1, included patients undergoing dissection of gall bladder by harmonic scalpel with application of one titanium clip on cystic duct , Group 2 included patients undergoing dissection of gall bladder by harmonic scalpel with application of two titanium clips on cystic duct , Group 3 included patients undergoing dissection of gall bladder by harmonic scalpel with application of absorbable Vikyl suture on cystic duct. In all these groups the cystic artery was divided with harmonic ace without use of clips and the gall bladder was also dissected throughout with the use of the harmonic ace. Group 4 included patients undergoing gall bladder dissection by conventional method of electrocautery and application of 3 clips each on the cystic duct and artery before division. Both intra and post operative were assessed and analysed statistically.
Results:
Out of the 200 patients, ,157 were females and 43 were males. Mean operative time was statistically significant when CLC was compared with SCLC, TCLC and CLLC (CLC 43.10 ± 9.68 min vs 26.80 ± 8.44 in SCLC, 28.76 ± 8.23 IN TCLC , 37.30 ± 8.22min in CLLC group). Approximate blood loss in the CLC group was 28.90 ± 11.71ml as compared to 7.8 ± 3.06 in SCLC, 8.10 ± 3.18 ml in TCLC and 8.40 ± 3.70 ml in the CLLC group. Pain score was significantly better in the SCLC, TCLC and CLLC group. 16 patients required drains in the CLC group as compared to 2 in SCLC, 3 in TCLC and 4 in the CLC group. Conversion to open cholecystectomy was comparable in all the groups. Post operative complication in the form of hematoma was significantly more in the CLC group. Overall cost was significantly high in the CLC as compared to the other groups.
Conclusion:
SCLC, TCLC and CLLC are comparable to standard 6 clip laparoscopic cholecystectomy in all aspects. SCLC and TCLC have a clear advantage of decreased operative time and blood loss. In addition, all these techniques have a lower cost as compared to conventional laparoscopic cholecystectomy. Further studies involving a large cohort of patients may lead to SCLC, TCLC and CLLC becoming the new standard of laparoscopic cholecystectomy.
Introduction: Gallstones are a common digestive disorder that constitutes a significant health problem. The incidence of cholelithiasis varies greatly and Laparoscopic cholecystectomy has been accepted as the “gold standard” for the treatment of symptomatic gallstone disease. Advanced energy source mainly harmonic scalpel, provide the advantage of shorter operating time by reducing smoke, bloodless dissection in calot’s triangle, lower risk of bleeding from cystic artery due to secure vessel sealing and reducing use of large number of titanium clips. Conventionally 6 titanium clips are used for laparoscopic cholecystectomy, 3 for cystic duct and 3 for cystic artery before division. The cost for using 6 titanium clips are high, therefore by using lesser number of titanium clips we aimed at reducing overall cost as well as time used in laparoscopic cholecystectomy. In addition, various studies have reported that clips have been associated with complications in form of migration.
We compared the advantages of single clip laparoscopic cholecystectomy (SCLC), two clips laparoscopic cholecystectomy (TCLC) and clipless laparoscopic cholecystectomy (CLLC) using single vikryl suture using harmonic ace with conventional laparoscopic cholecystectomy (CLC) using 6 clips and standard electrocautery.
Material and Methods: This study included 200 patients of proven gallstones over a period of 1 year. Patients were randomly divided into four groups with each group consisting of 50 patients. Group 1, included patients undergoing dissection of gall bladder by harmonic scalpel with application of one titanium clip on cystic duct , Group 2 included patients undergoing dissection of gall bladder by harmonic scalpel with application of two titanium clips on cystic duct , Group 3 included patients undergoing dissection of gall bladder by harmonic scalpel with application of absorbable Vikyl suture on cystic duct. In all these groups the cystic artery was divided with harmonic ace without use of clips and the gall bladder was also dissected throughout with the use of the harmonic ace. Group 4 included patients undergoing gall bladder dissection by conventional method of electrocautery and application of 3 clips each on the cystic duct and artery before division. Both intra and post operative were assessed and analysed statistically.
Results:
Out of the 200 patients, ,157 were females and 43 were males. Mean operative time was statistically significant when CLC was compared with SCLC, TCLC and CLLC (CLC 43.10 ± 9.68 min vs 26.80 ± 8.44 in SCLC, 28.76 ± 8.23 IN TCLC , 37.30 ± 8.22min in CLLC group). Approximate blood loss in the CLC group was 28.90 ± 11.71ml as compared to 7.8 ± 3.06 in SCLC, 8.10 ± 3.18 ml in TCLC and 8.40 ± 3.70 ml in the CLLC group. Pain score was significantly better in the SCLC, TCLC and CLLC group. 16 patients required drains in the CLC group as compared to 2 in SCLC, 3 in TCLC and 4 in the CLC group. Conversion to open cholecystectomy was comparable in all the groups. Post operative complication in the form of hematoma was significantly more in the CLC group. Overall cost was significantly high in the CLC as compared to the other groups.
Conclusion:
SCLC, TCLC and CLLC are comparable to standard 6 clip laparoscopic cholecystectomy in all aspects. SCLC and TCLC have a clear advantage of decreased operative time and blood loss. In addition, all these techniques have a lower cost as compared to conventional laparoscopic cholecystectomy. Further studies involving a large cohort of patients may lead to SCLC, TCLC and CLLC becoming the new standard of laparoscopic cholecystectomy.
Abstract:
Introduction: Gallstones are a common digestive disorder that constitutes a significant health problem. The incidence of cholelithiasis varies greatly and Laparoscopic cholecystectomy has been accepted as the “gold standard” for the treatment of symptomatic gallstone disease. Advanced energy source mainly harmonic scalpel, provide the advantage of shorter operating time by reducing smoke, bloodless dissection in calot’s triangle, lower risk of bleeding from cystic artery due to secure vessel sealing and reducing use of large number of titanium clips. Conventionally 6 titanium clips are used for laparoscopic cholecystectomy, 3 for cystic duct and 3 for cystic artery before division. The cost for using 6 titanium clips are high, therefore by using lesser number of titanium clips we aimed at reducing overall cost as well as time used in laparoscopic cholecystectomy. In addition, various studies have reported that clips have been associated with complications in form of migration.
We compared the advantages of single clip laparoscopic cholecystectomy (SCLC), two clips laparoscopic cholecystectomy (TCLC) and clipless laparoscopic cholecystectomy (CLLC) using single vikryl suture using harmonic ace with conventional laparoscopic cholecystectomy (CLC) using 6 clips and standard electrocautery.
Material and Methods: This study included 200 patients of proven gallstones over a period of 1 year. Patients were randomly divided into four groups with each group consisting of 50 patients. Group 1, included patients undergoing dissection of gall bladder by harmonic scalpel with application of one titanium clip on cystic duct , Group 2 included patients undergoing dissection of gall bladder by harmonic scalpel with application of two titanium clips on cystic duct , Group 3 included patients undergoing dissection of gall bladder by harmonic scalpel with application of absorbable Vikyl suture on cystic duct. In all these groups the cystic artery was divided with harmonic ace without use of clips and the gall bladder was also dissected throughout with the use of the harmonic ace. Group 4 included patients undergoing gall bladder dissection by conventional method of electrocautery and application of 3 clips each on the cystic duct and artery before division. Both intra and post operative were assessed and analysed statistically.
Results:
Out of the 200 patients, ,157 were females and 43 were males. Mean operative time was statistically significant when CLC was compared with SCLC, TCLC and CLLC (CLC 43.10 ± 9.68 min vs 26.80 ± 8.44 in SCLC, 28.76 ± 8.23 IN TCLC , 37.30 ± 8.22min in CLLC group). Approximate blood loss in the CLC group was 28.90 ± 11.71ml as compared to 7.8 ± 3.06 in SCLC, 8.10 ± 3.18 ml in TCLC and 8.40 ± 3.70 ml in the CLLC group. Pain score was significantly better in the SCLC, TCLC and CLLC group. 16 patients required drains in the CLC group as compared to 2 in SCLC, 3 in TCLC and 4 in the CLC group. Conversion to open cholecystectomy was comparable in all the groups. Post operative complication in the form of hematoma was significantly more in the CLC group. Overall cost was significantly high in the CLC as compared to the other groups.
Conclusion:
SCLC, TCLC and CLLC are comparable to standard 6 clip laparoscopic cholecystectomy in all aspects. SCLC and TCLC have a clear advantage of decreased operative time and blood loss. In addition, all these techniques have a lower cost as compared to conventional laparoscopic cholecystectomy. Further studies involving a large cohort of patients may lead to SCLC, TCLC and CLLC becoming the new standard of laparoscopic cholecystectomy.
Introduction: Gallstones are a common digestive disorder that constitutes a significant health problem. The incidence of cholelithiasis varies greatly and Laparoscopic cholecystectomy has been accepted as the “gold standard” for the treatment of symptomatic gallstone disease. Advanced energy source mainly harmonic scalpel, provide the advantage of shorter operating time by reducing smoke, bloodless dissection in calot’s triangle, lower risk of bleeding from cystic artery due to secure vessel sealing and reducing use of large number of titanium clips. Conventionally 6 titanium clips are used for laparoscopic cholecystectomy, 3 for cystic duct and 3 for cystic artery before division. The cost for using 6 titanium clips are high, therefore by using lesser number of titanium clips we aimed at reducing overall cost as well as time used in laparoscopic cholecystectomy. In addition, various studies have reported that clips have been associated with complications in form of migration.
We compared the advantages of single clip laparoscopic cholecystectomy (SCLC), two clips laparoscopic cholecystectomy (TCLC) and clipless laparoscopic cholecystectomy (CLLC) using single vikryl suture using harmonic ace with conventional laparoscopic cholecystectomy (CLC) using 6 clips and standard electrocautery.
Material and Methods: This study included 200 patients of proven gallstones over a period of 1 year. Patients were randomly divided into four groups with each group consisting of 50 patients. Group 1, included patients undergoing dissection of gall bladder by harmonic scalpel with application of one titanium clip on cystic duct , Group 2 included patients undergoing dissection of gall bladder by harmonic scalpel with application of two titanium clips on cystic duct , Group 3 included patients undergoing dissection of gall bladder by harmonic scalpel with application of absorbable Vikyl suture on cystic duct. In all these groups the cystic artery was divided with harmonic ace without use of clips and the gall bladder was also dissected throughout with the use of the harmonic ace. Group 4 included patients undergoing gall bladder dissection by conventional method of electrocautery and application of 3 clips each on the cystic duct and artery before division. Both intra and post operative were assessed and analysed statistically.
Results:
Out of the 200 patients, ,157 were females and 43 were males. Mean operative time was statistically significant when CLC was compared with SCLC, TCLC and CLLC (CLC 43.10 ± 9.68 min vs 26.80 ± 8.44 in SCLC, 28.76 ± 8.23 IN TCLC , 37.30 ± 8.22min in CLLC group). Approximate blood loss in the CLC group was 28.90 ± 11.71ml as compared to 7.8 ± 3.06 in SCLC, 8.10 ± 3.18 ml in TCLC and 8.40 ± 3.70 ml in the CLLC group. Pain score was significantly better in the SCLC, TCLC and CLLC group. 16 patients required drains in the CLC group as compared to 2 in SCLC, 3 in TCLC and 4 in the CLC group. Conversion to open cholecystectomy was comparable in all the groups. Post operative complication in the form of hematoma was significantly more in the CLC group. Overall cost was significantly high in the CLC as compared to the other groups.
Conclusion:
SCLC, TCLC and CLLC are comparable to standard 6 clip laparoscopic cholecystectomy in all aspects. SCLC and TCLC have a clear advantage of decreased operative time and blood loss. In addition, all these techniques have a lower cost as compared to conventional laparoscopic cholecystectomy. Further studies involving a large cohort of patients may lead to SCLC, TCLC and CLLC becoming the new standard of laparoscopic cholecystectomy.
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