Title: Cystic Artery Haemostatic Control During Laparoscopic Cholecystectomy- Clips Or Bipolar Cautery - A Comparative Study
Authors: Ballapalli Hariprasad, Mahidhar Reddy Venkatapuram, Sreeram Satish
DOI: http://dx.doi.org/10.18535/jmscr/v3i10.62
Abstract
Aim of the study- we conducted this study to know which method is best,clip application or bipolar cautery, to secure haemostasis of cystic artery during laparoscopic cholecystectomy,
Methodology- a prospective comparative study was done on two groups of patients undergoing laparoscopic cholecystectomy1 where in cystic artery was clipped in group A and it was cauterized with bipolar device in group B. 50 patients were assigned to each group.
Results- in both the groups no one had postoperative bleeding. intraoperatively, in group A one patient needed reapplication of clip2 to cystic artery due to its slippage whereas in group B two patients had bleed from cystic artery after cauterization with bipolar device, which was subsequently controlled by clip application.
Conclusion-both clip application and bipolar cauterization are equally efficacious in gaining haemostasis of cystic artery during laparoscopic cholecystectomy.
Keywords- laparoscopic cholecystectomy, cystic artery, clips, bipolar cautery
References
1. Zucker KA. Surgical Laparoscopy. 2nd Ed. Philadelphia.Lippincott Williams and Wilkins 2001:130-141.
2. Westervelt J. Clipless cholecystectomy: Broadening the role of harmonic scalpel. JSLS. 2004;8(3):283-285.
3. Azeem M, Abbas SM, Wirk NM, Durrani K. Bile duct Injuries during laparoscopic cholecystectomy- two years experience at Sheikh Zaid Hospital, mechanism of injury, prevention and management. Ann King Edward Med Coll 2001;7:238-741.
4. Huscher CG, Lirici MM, Di Paola M, Crafa F, Napolitano C, Mereu A, et al. Laparoscopic cholecystectomy by ultrasonic dissection without cystic duct and artery ligature. Surg Endosc. 2003;17(3):442-451.
5. Strasberg SM. Avoidance of biliary injury during laparoscopic cholecystectomy. J Hepatobiliary Pancreat Surg.2002;9:543-547.
6. Khan S, Oonwala ZG. An audit of Laparoscopic Cholecystectomy, Pak J Surg. 2007;23:100-103.
7. Suzuki M, Akaishi S, Rikiyama T, Naitoh T, Rahman MM, Matsuno S. Laparoscopic cholecystectomy, Calot’s triangle, and variations in cystic arterial supply. Surg Endosc. 2000;14:141-144.
8. Hugh TB, Kelly MD, Li B. Laparoscopic anatomy of the cystic artery. Am J Surg. 1992;163:593-595.
9. Langenbuch C. A case of extirpation of the gallbladder for chronic cholecystitis. Cure. (Berlin) 1882; 19:725-727.
10. Soper NJ, Barteau JA, Claymann RV, Becich MJ; Safety and efficacy of laparoscopic cholecystectomy using monopolar electrocautery in the porcine model. Surg Laparosc Endosc., 1991; 1(1):17-22.
11. Champault A, Vons C, Dagher I, Amerlinck S, Franco D; Low-cost laparoscopic cholecystectomy. Br J Surg., 2002; 89(12):1602-1607.
12. Hannan MJ, Hogue MM; Laparoscopic cholecystectomy without handling the cystic artery: a new approach to minimize complications. J Laparoendosc Adv Surg Tech A., 2011; 21(10): 983-986