Randomized clinical trial of ultrasonicversuselectrocautery dissection of the gallbladder in laparoscopic cholecystectomy

British Journal of Surgery - Tập 90 Số 7 - Trang 799-803 - 2003
Ignace M. C. Janssen1, Dingeman J. Swank2, O.W.A. Boonstra1, Ben C. Knipscheer1, Jean H. G. Klinkenbijl1, Harry van Goor3
1Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands
2Department of Surgery, Groene Hart Hospital, Gouda, The Netherlands
3Department of Surgery, University Medical Centre, Nijmegen, The Netherlands

Tóm tắt

AbstractBackgroundLaparoscopic cholecystectomy is frequently complicated by gallbladder perforation and loss of bile or stones into the peritoneal cavity. The aim of this study was to compare the use of ultrasonic dissection and electrocautery with respect to the incidence of gallbladder perforation and intraoperative consequences.MethodsBetween January 1998 and January 2000, 200 patients undergoing elective laparoscopic cholecystectomy were randomized to electrocautery or ultrasonic dissection of the gallbladder. The main outcome measures were gallbladder perforation, operating time and the number of times the lens was cleaned. Univariate and multivariate analyses were performed.ResultsThe perforation rate differed significantly: 16 per cent for ultrasonic dissection (n = 96) and 50 per cent for electrocautery (n = 103) (P < 0·001). The operating time of the least experienced surgeons, who had performed fewer than ten laparoscopic cholecystectomies, was significantly shorter when ultrasonic dissection was used, compared with electrocautery. The number of times the lens needed to be cleaned was significantly lower when ultrasonic dissection was used in complicated gallbladders (P < 0·035). At logistic regression analysis, the risk of perforation in the electrocautery group was about four times higher (odds ratio 0·26, P < 0·001) than that in the ultrasonic group. When the groups were matched for prognostic factors, including body mass index and surgical experience, the results were similar to those obtained with univariate and multivariate analysis.ConclusionThe use of ultrasonic dissection in laparoscopic cholecystectomy reduces the incidence of gallbladder perforation and helps the operation to progress. Less experienced surgeons benefit most from ultrasonic dissection, particularly in complicated intraoperative circumstances.

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Tài liệu tham khảo

The Southern Surgeons Club, 1991, A prospective analysis of 1518 laparoscopic cholecystectomies, N Engl J Med, 324, 1073, 10.1056/NEJM199104183241601

Cuschieri, 1991, The European experience with laparoscopic cholecystectomy, Am J Surg, 161, 385, 10.1016/0002-9610(91)90603-B

Gouma, 1994, Gallstone treatment in the ‘laparoscopic cholecystectomy era’, Neth J Med, 45, 1

Keulemans, 1997, Experiences with outpatient laparoscopic cholecystectomy, Ned Tijdschr Geneeskd, 141, 686

Prasad, 1996, Day case laparoscopic cholecystectomy: a safe and cost effective procedure, Eur J Surg, 162, 43

Keulemans, 1998, Laparoscopic cholecystectomy: day-care versus clinical observation, Ann Surg, 228, 734, 10.1097/00000658-199812000-00003

Diez, 1998, Lost stones during laparoscopic surgery, HPB Surg, 11, 105, 10.1155/1998/95874

Sarli, 1999, Gallbladder perforation during laparoscopic cholecystectomy, World J Surg, 23, 1186, 10.1007/s002689900644

Catarci, 1993, Lost intraperitoneal stones after laparoscopic cholecystectomy: harmless sequela or reason for reoperation?, Surg Laparosc Endosc, 3, 318

Mellinger, 1994, Delayed gallstone abscess following laparoscopic cholecystectomy, Surg Endosc, 8, 1332, 10.1007/BF00188294

Hui, 1999, Iatrogenic gallbladder perforation during laparoscopic cholecystectomy: etiology and sequelae, Am Surg, 65, 944, 10.1177/000313489906501010

Birch, 1999, Acute thermal injury to the canine jejunal free flap: electrocautery versus ultrasonic dissection, Am Surg, 65, 334, 10.1177/000313489906500410

Ronan, 2000, Radial artery harvest: comparison of ultrasonic dissection with standard technique, Ann Thorac Surg, 69, 113, 10.1016/S0003-4975(99)01193-5

Lamm, 2000, The harmonic scalpel: optimizing the quality of mammary artery bypass grafts, Ann Thorac Surg, 69, 1833, 10.1016/S0003-4975(00)01288-1

Slotman, 1995, Laparoscopic lumbar diskectomy: preliminary report of a minimally invasive anterior approach to the herniated L5–S1 disk, Surg Laparosc Endosc, 5, 363

Ohtsuka, 2000, New instrumentation for video-assisted anterior spine release, Surg Endosc, 14, 682, 10.1007/s004640020077

Buscher, 2002, Long-term results of bilateral thoracoscopic splanchnicectomy in patients with chronic pancreatitis, Br J Surg, 89, 158, 10.1046/j.1365-2168.2002.01988.x

Ohtsuka, 2000, Ultrasonic coagulator for video-assisted internal mammary artery harvest, Surg Endosc, 14, 82, 10.1007/s004649900018

Elashry, 1997, Recent advances in laparoscopic partial nephrectomy: comparative study of electrosurgical snare electrode and ultrasound dissection, J Endourol, 11, 15, 10.1089/end.1997.11.15

Crolla, 1997, Complication rate in laparoscopic cholecystectomy not different for residents in training and surgeons, Ned Tijdschr Geneeskd, 141, 681

De Simone, 1999, The risk of gallbladder perforation at laparoscopic cholecystectomy, Surg Endosc, 13, 1099, 10.1007/s004649901181

Tsimoyiannis, 1998, Laparoscopic cholecystectomy using ultrasonically activated coagulating shears, Surg Laparosc Endosc, 8, 421, 10.1097/00019509-199812000-00004

Ammori, 2001, Laparoscopic cholecystectomy in morbidly obese patients, Surg Endosc, 15, 1336, 10.1007/s004640000019

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British Journal of Surgery

Tập 90 Số 7

799-803

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