Comparison of sealers used in laparoscopic cholecystectomy for cystic duct closure: An ex vivo study

Özet

Introduction: To compare the safety and efficacy of Harmonic scalpel (HS) and Plasmakinetic (PK) sealer inachieving safe closure of the cystic ducts ex–vivo after the laparoscopic cholecystectomy.Materials and Methods: In this prospective study, 90 patients with symptomatic gallstone disease wereoperated using laparoscopic technic. Then gallbladders were divided into three groups (n=30). In all groups,gallbladders were removed with surgical clips. After the gallbladders removed, in first group, cystic ductsremain clipped (SC). In second and third groups, cystic ducts were sealed with HS and PK distally afterthe surgical clips removed. Then, twenty–gauge catheters were applied to fundic part of gallbladder andgallbladders filled with saline. An increasing pressure was applied through a sphygmomanometer. Burstingpressures were measured using invasive arterial blood pressure measurement device and measured systolic pressures were accepted bursting pressure. After bursting pressures were measured in three groups,results were written down to the SPSS table. Differences between HSvsSC, HSvsPK and SCvsPK groupswere calculated using paired–samples t–test.Results: In this study, the mean cystic duct bursting pressures were 332.46±4.62 mm Hg with SC, 326.56±4.53mmHg with PK and 343.06±4.28 mm Hg with HS. Differences in the mean cystic duct bursting pressures between HS vs. SC and HS vs. PK groups were indicated HS’s superiority (p=0.046 and p=0.026, respectively).On the contrary, SC vs. PK group was not indicated PK’s advantage; however, PK was found safely as muchas SC.Conclusion: HS and PK sealer could be an alternative and safe method for cystic duct closure, avoiding theclip displacement and migration of the clip. Single device usage was one of the most important advantagesof this technique. Thus, intraabdominal organ injuries will be lessened.