Clipless Laparoscopic Cholecystectomy Using Harmonic Scalpel in Cirrhotic Patients a Prospective Randomized Study
Condition: Gall Bladder Stone in Cirrhotics
MeSH terms: Cholelithiasis; Cholecystolithiasis; Gallstones; Urinary Bladder Calculi
Study type: Interventional

Summary: 
      This study included group (A) (60 patients with liver cirrhosis and complaining of gall
      stone) in whom LC was done using traditional method (TM) by clipping both cystic duct and
      artery and dissection of gall bladder from liver bed by diathermy, and group (B) (60 patients
      with liver cirrhosis and complaining of gall stone) LC was done using harmonic scalpel (HS)
      closure and division of both cystic duct, artery and dissection of gall bladder from liver
      bed by harmonic scalpel. The Intraoperative and postoperative parameters were collected
      included duration of operation, postoperative pain, and complications.
    

Detailed description: 
      Under general anesthesia, and same antibiotics (3rd generation cephalosporin) Surgery was
      performed using conventional four ports umbilical port, port below xiphoid and two ports
      below right costal margin. Pneumoperitoneum at pressure 12 mmHg was used.

      In group (A) LC was done using traditional method by dissection of calot's triangle and
      clipping of both cystic duct and artery by metal clips. Then dissection of gall bladder from
      its bed by hook using electrocautery technique. Finally we insert abdominal drain in Morrison
      pouch.

      In group (B) LC was done using harmonic ACE (Ethicon Endo-Surgery) by dissection of calot's
      and then occlusion of both cystic duct and artery using harmonic ACE. For closure of and
      division of cystic pedicle we set the instrument at a power 2 i.e. more coagulation. And when
      dissecting the gall bladder from the bed we set it to the level 5 i.e. more cutting power.
      And control of any bleeding from the bed using the active blade of harmonic ACE. Finally we
      insert abdominal drain in Morrison pouch.

      The Intraoperative parameter observed included duration of the operation, bile escape and
      volume of blood loss were recorded The patients started oral feeding 8 h postoperatively;
      abdominal ultrasound was done for all patients in both groups on day of discharge to show any
      collection or free fluid in the abdomen. The patients were usually discharged after removal
      of drain, and when the patient surgically free.

      Postoperative pain was evaluated at 12 h, 24h, 48, 1 w after operation using a visual analog
      scale (VAS)
    

Intervention name(s): LC was done using traditional method; LC was done using harmonic ACE
Intervention type(s): Procedure; Procedure
Intervention description(s): LC was done using traditional method by dissection of calot's triangle and clipping of both cystic duct and artery by metal clips. Then dissection of gall bladder from its bed by hook using electrocautery technique. Finally we insert abdominal drain in Morrison pouch.; LC was done using harmonic ACE (Ethicon Endo-Surgery) by dissection of calot's and then occlusion of both cystic duct and artery using harmonic ACE. For closure of and division of cystic pedicle we set the instrument at a power 2 i.e. more coagulation. And when dissecting the gall bladder from the bed we set it to the level 5 i.e. more cutting power. And control of any bleeding from the bed using the active blade of harmonic ACE. Finally we insert abdominal drain in Morrison pouch.
Other intervention name(s): traditional laparoscopic cholecystectomy; clipless laparoscopic cholecystectomy
Allocation: Randomized
Intervention model: Single Group Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: cirrhotic liver, gall bladder stone