caa a22 4500 47578183X CHVBK 20180406123646.0 cr unu---uuuuu 170329e20001101xx s 000 0 eng 10.1007/s004640000034 doi (NATIONALLICENCE)springer-10.1007/s004640000034 Use of the ultrasonic dissecting scalpel in laparoscopic cholecystectomy [Elektronische Daten] [C. Power, D. Maguire, O. J. McAnena, J. Calleary] Background: We evaluated the use of the ultrasonically activated (harmonic) scalpel (HS) in the performance of laparoscopic cholecystectomy (LC). Methods: A total of 282 consecutive patients, 64 of whom had acute cholecystitis at the time of surgery, underwent LC using HS dissection. Indications for surgery included chronic pain (180 cases), episodes of acute cholecystitis (89 cases), pancreatitis (five cases), and jaundice (seven cases). Twenty-seven patients had preoperative endoscopic retrograde cholangiopancreatography (ERCP). Results: The mean operating time was 29 ± 9 mins. Eleven procedures were converted to open surgery, (four due to bleeding, six due to unclear anatomy, and one due to an inflammatory mass caused by gangrene/perforation). Complications occurred in 14 patients. They included minor port site infection (four cases), pulmonary atelectasis (three cases), urinary retention (two cases), intraoperative cathetherization not routinely performed, bile leak (two cases, both from cystic duct; one of the cystic duct leaks occurred because of dislodgement of the occluding clip, the other may have been due to duct injury from the clip), pulmonary embolus (one case), and myocardial infarction (one case). Neither of the latter complications were fatal. One patient required a postoperative transfusion due to a fall in hematocrit of 3.2 gr/dl. Conclusions: LC performed with the HS is feasible and effective. Operating time and blood loss were minimal, and the conversion rate was low (3.9%). There were no bile duct injuries. Use of the HS makes dissection easier, thereby helping to reduce operative time and lower the need for conversion to open surgery. Springer-Verlag New York Inc., 2000 Key words: Cholecystectomy — Gallbladder — Harmonic scalpel — Laparoscopy — Ultrasonic dissection nationallicence Power C. Department of Surgery, University College Hospital, Galway, Ireland, IE aut Maguire D. Department of Surgery, University College Hospital, Galway, Ireland, IE aut McAnena O. J. Department of Surgery, University College Hospital, Galway, Ireland, IE aut Calleary J. Department of Surgery, University College Hospital, Galway, Ireland, IE aut https://doi.org/10.1007/s004640000034 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s004640000034 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Power C. Department of Surgery, University College Hospital, Galway, Ireland, IE aut NATIONALLICENCE 700 1- Maguire D. Department of Surgery, University College Hospital, Galway, Ireland, IE aut NATIONALLICENCE 700 1- McAnena O. J. Department of Surgery, University College Hospital, Galway, Ireland, IE aut NATIONALLICENCE 700 1- Calleary J. Department of Surgery, University College Hospital, Galway, Ireland, IE aut Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer