Harmonic Scalpel versus Monopolar Electrocauterization in laparoscopic cholecystectomy

Background: Gallstone treatment with laparoscopic cholecystectomy (LC) is considered the "gold standard". In laparoscopic cholecystectomy, ultrasonic dissection has become a viable substitute for monopolar electrocautery, perhaps lowering the possibility of gallbladder perforation and causing less tissue damage. The technique uses high-frequency ultrasonic energy to dissect and coagulate tissue, which reduces collateral heat injury.Aim: To contrast the safety, efficacy, and operating time of a Harmonic Scalpel with a Monopolar Electrocautery in a laparoscopic cholecystectomy.Patients and Methods: Research on one hundred patients who had laparoscopic cholecystectomy between December 2021 and December 2022 was conducted at Al-Zahraa University Hospital. There were two equal groups of patients: Group (A) underwent the customary procedure of utilizing monopolar electrocautery to split the cystic duct and artery and remove the gallbladder from the liver bed, while Group (B) received the same procedure but with a harmonic scalpel.Results: Conventional laparoscopic cholecystectomy (CLC) was associated with significantly more frequent camera cleaning compared to harmonic laparoscopic cholecystectomy (HLC) (2.3 ± 0.8 vs 0.1 ± 0.3, P < .001). Furthermore, the median operating time was substantially longer in the monopolar group (55 ± 17.9 minutes) than in the harmonic group (47.9 ± 11.8 minutes) (P = .022). No statistically substantial variation was found between group A and group B regarding age, BMI, gender, associated comorbidities, ASA physical state, underlying gall bladder disease, and postoperative hospital stay.Conclusion: Ultrasonic dissection has several advantages over electrocautery, including the use of a single device for both gallbladder and artery dissections, a quicker operating time, better laparoscopic vision, and a lower incidence of gall bladder perforations. However, the biggest downside is its expensive cost.