Clipless Versus Conventional Laparoscopic Cholecystectomy Using Harmonic Scalpel

Clipless Versus Conventional Laparoscopic Cholecystectomy Using Harmonic Scalpel: A Randomized Controlled Trial From a Tertiary Care Centre in Pakistan

This randomized controlled trial compares the operative outcomes of clipless laparoscopic cholecystectomy using a harmonic scalpel (HS) versus conventional clip-based laparoscopic cholecystectomy (CLC) in patients with gallstone disease. The primary goals are to determine if the clipless HS technique reduces operative time and intraoperative blood loss. Secondary outcomes include the length of postoperative hospital stay and the rate of port-site infections.

Conventional laparoscopic cholecystectomy (CLC) uses metal clips to control the cystic duct and artery. Potential complications include clip slippage, which can lead to bleeding or bile leak, and clips acting as a nidus for future stone formation. The harmonic scalpel (HS) uses ultrasonic energy to simultaneously cut and coagulate tissue, allowing for dissection and sealing of vessels without clips. This single-center randomized controlled trial, conducted at Services Hospital, Lahore, Pakistan, enrolled 158 adults scheduled for elective laparoscopic cholecystectomy. Participants were randomly assigned to either undergo a clipless cholecystectomy with a harmonic scalpel (Group A) or a conventional clip-based cholecystectomy with monopolar electrocautery (Group B). All procedures were performed by the same experienced surgical team. The study aims to provide evidence on the safety and efficiency of the clipless HS technique in a high-volume public hospital setting.

Inclusion Criteria:

• Adults aged 20-70 years.
• Diagnosis of gallstone disease confined to the gallbladder.
• Scheduled for elective laparoscopic cholecystectomy.

Exclusion Criteria:

• ASA (American Society of Anesthesiologists) physical status class III or IV.
• Renal dysfunction (serum creatinine > 2.0 mg/dL).
• Coagulopathy (PT >1 s above control, aPTT >33 s, INR >1.5).
• Pregnancy.
• Presence of common bile duct stones.
• Previous upper abdominal surgery or laparotomy.