Clipless Laparoscopic Cholecystectomy with Knot Pusher: Experience from More Than 500 Cases

Objective: This study aims to demonstrate that laparoscopic cholecystectomy utilizing the extracorporeal sliding knot technique with a knot pusher can achieve satisfactory outcomes, such as no dislodgement of the tied cystic duct and minimal complications. The technique was efficient, secure, and cost-effective, with no instances of accidental knot failure observed, and requiring only a single nylon suture for knot tying. Materials and Methods: A retrospective study was conducted on the elective symptomatic gallstone disease treatment outcomes via LC utilizing the extracorporeal sliding knot technique with a knot pusher. The diagnosis was confirmed in all cases using ultrasound, and no instances of acute cholecystitis were included in this study. This study was carried out at the General Surgery Department of Chiangrai Prachanukroh Hospital between September 2008 and August 2019. Results: The results of this study indicated favorable outcomes for LC performed using this method. A total of 512 patients were included, comprising 94 males and 418 females. The mean age of the participants was 49.1 years, with an age range of 21 to 91 years. The average duration of surgery was 35 minutes, ranging from 16 to 72 minutes. Blood loss during surgery averaged 15 ml, ranging from 2 to 120 ml. The average hospital stay was 2.5 days, ranging from 1 to 5 days. No serious complications related to cystic duct ligation were observed using the extracorporeal sliding knot technique. The average time required to tie all knots in each case was 4 minutes, ranging from 2 to 7 minutes. Conclusion: Laparoscopic cholecystectomy using the extracorporeal sliding knot technique with a knot pusher enhances cystic duct closure efficiency by simplifying surgery, lowering complications, and reducing costs. It ensures secure closure, is easy to learn, and adds minimal time to the procedure compared to clipping, making it an effective alternative technique.