Safety and Efficiency of Harmonic Laparoscopic Dissecting Hook in Gallbladder Dissection and Hemostasis of Gallbladder Bed in Comparison to Electrocautery Hook During Laparoscopic Cholecystectomy
Background: Many devices have been used during surgery for dissection and hemostasis of gallbladder (GB) from liver bed;
the most commonly used are electrocautery and ultrasonically activated devices. Harmonic hook (HH) can achieve cutting and
coagulation device offering dissection and hemostasis in a way equivalent to electrocautery hook (EH).
Materials and Methods: This is a prospective comparative study where sample of 60 Iraqi patients of either gender was selected.
Sample was divided into two groups; 30 in the first group, EH was used for dissection, and 30 in the second group, HH was used
for achieving the dissection (laparoscopic dissecting hook Ethicon Endosurgery LLC©).
Results: The total number of patients who were candidate for laparoscopic cholecystectomy was 60. Sample divided into two
groups. The first is EH group operative time was calculated with mean time of 60 ± 13.7 min and GB dissection mean time
(24.5 ± 8.5 min). Intraoperative challenges were recorded as minor bleeding in 25 patients (83.33%), moderate in 2 (10%) and
no bleeding in 3 patients (6.67%), GB perforation in 18 patients (60%), bile leak in 1 patient (3.33%), stone spillage in 6 (20%)
patients, and need for scope lens cleaning in 23 (76.67%) patients. The second is HH group mean operative time (50 ±14.3 min)
and GB dissection mean time (18 ± 4.8 min). Intraoperative challenges were recorded as minor bleeding in 9 patients (30%) and
no bleeding in 21 patients (70%), GB perforation in 1 patient (3.33%), no bile leak nor stone spillage was recorded, and need for
scope lens cleaning in 2 patients (6.67%).
Conclusion: Ultrasonic dissection by HH is safe and effective modality of dissection of GB and hemostasis in laparoscopic
cholecystectomy and can replace electrocautery for this purpose if available at operative theater.
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