Prospective analysis of 101 consecutive cases of laparoscopic cholecystectomy for acute cholecystitis operated with harmonic scalpel.

BACKGROUND: Videolaparocholecystectomy (VLC) for acute cholecystitis (AC) is a technically demanding procedure, feasible by experienced surgeons, still affected by high conversion rate. Aim of this study was to prospectively evaluate whether the use of harmonic scalpel (HA) during VLC for AC, allowing a potentially better hemostasis and biliostasis, can decrease the conversion rate.

METHODS: Hundred and one patients, with the mean age of 61.2+/-8.2 years (range: 39 to 81 y), admitted for AC, have been submitted to early VLC with HA within 6 years (from January 1, 2003 to December 31, 2008) at the Department of General, Emergency, and Transplant Surgery of St Orsola-Malpighi University Hospital in Bologna, Italy. The design of the study was prospective observational non-randomized. The control group consisted of 100 patients who underwent VLC for AC without HA at the same department in the same period.

RESULTS: Mean operative time in VLC group with HA has been 71.4+/-14.3 minutes (range: 42 to 112 min) versus 87.4+/-10.8 minutes in the control group (P<0.001). Blood losses were significantly lower with the use of HA. Conversion rate has been 4.9%, mortality was 1%, and postoperative morbidity 7.9% in HA treated group, versus 12% conversion rate, 1% and 9% mortality and morbidity, respectively in the control group (P value not significant).

CONCLUSIONS: The use of HA seems to be associated with lower conversion rate in VLC for AC, without any significant increase of morbidity. HA might be even more useful in the most technically demanding cases but further investigations are required. A prospective randomized trial comparing harmonic versus monopolar diathermy in laparoscopic cholecystectomy for AC in adults (Harmonic for Acute Cholecystitis Trial, NCT00746850) is currently enrolling patients and will clarify these observations.