Improved outcome after laparoscopic cholecystectomy with ultrasonic dissection: a randomized multicenter trial
2010 (English)In: Surgical Endoscopy, ISSN 0930-2794, E-ISSN 1432-2218, Vol. 24, no 3, 624-630 p.Article in journal (Refereed) Published
In conventional laparoscopic cholecystectomy, dissection with electrocautery starts at the triangle of Calot. In a randomized single-center trial, the fundus-first method (dome down) using ultrasonic dissection was faster, involved less pain or nausea, and had a shorter postoperative sick leave. This may relate to the fundus-first method or to the ultrasonic dissection. In a multicenter trial, 243 elective patients were randomized to conventional laparoscopic cholecystectomy using electrocautery (n = 85) or the fundus-first method using either electrocautery (n = 81) or ultrasonic dissection (n = 77). The fundus-first method had a shorter operating time with ultrasonic dissection (58 min) than with electrocautery (74 min; p = 0.002). The fundus-first method using ultrasonic dissection compared with electrocautery or the conventional method produced less blood loss (12 vs. 53 or 36 ml; p < 0.001) and fewer gallbladder perforations (26% vs. 46% or 49%; p = 0.005). Also, the pain and nausea scores at 4 and 6 h were lower, and the sick leave was shorter (6.1 vs. 9.4 and 9 days, respectively; p < 0.001). The fundus-first method using ultrasonic dissection is associated with less blood loss, fewer gallbladder perforations, less pain and nausea, and shorter sick leave than the conventional and fundus-first method using electrocautery. The difference seems related to the use of ultrasonic dissection.
Place, publisher, year, edition, pages
Springer, 2010. Vol. 24, no 3, 624-630 p.
complications, dome down, electrocautery, fundus-first, laparoscopic cholecystectomy, nausea, postoperative pain, ultrasonic dissection
IdentifiersURN: urn:nbn:se:umu:diva-109642DOI: 10.1007/s00464-009-0649-2ISI: 000274467500021PubMedID: 19688393OAI: oai:DiVA.org:umu-109642DiVA: diva2:858424