How to Cite

alam, shahid, Ahmad, M., & Shah, L. (2014). EARLY EXPERIENCE WITH ULTRASONIC (HARMONIC) DISSECTION DURING LAPAROSCOPIC CHOLECYSTECTOMY: IS IT SAFE AND ACHIEVABLE?. KHYBER MEDICAL UNIVERSITY JOURNAL, 6(2), 56-59. Retrieved from https://www.kmuj.kmu.edu.pk/article/view/11472


Objective: to evaluate the safety of ultrasonic (harmonic) dissection during laparoscopic cholecystectomy in terms of gall bladder perforation.

Methodology: This descriptive study was conducted at surgical B unit of Lady Reading Hospital Peshawar from July 2007 to December 2008, on 120 patients with symptomatic gallstones. Patients fulfilling the study criteria, were selected on consecutive non-probability sampling technique. All the patients were operated laproscopicaly through standard four-port technique. Ultrasonic device (harmonic) was used for GB dissection off its bed. Intraoperatively bile leak or stone spillage was looked for suggesting GB perforation.  The demographic and clinical (intraoperative) data of the all the patients were recorded in a proforma and data was analyzed with SPSS version-16.

Results:  The age of the patients ranged from 18 to 70 years with the maximum number in the 4th decade. The mean age was 40.15±12.632 years. The male to female ratio was 1: 6.66. The mean hospital stay was 3.37±0.766 days.  Patients with gall bladder perforation were 20 (16.7%) and 16.6% of the gall bladder perforation occurred in 21 to 50 years of age. The gall bladder perforation in male and female were 8.3% and 8.3% respectively.

Conclusion: Ultrasonic dissection of gall bladder from its bed is a safe technique and carried 16.7% risk of all bladder perforation. In resources limited countries, proper training of laparoscopic surgery should be encouraged.



Peterson-Brown P, Garden OJ, Carter DC. Laparoscopic cholecystectomy. Br J Surg 1991;78:131.

Baer ST, Pozarliev T, Todorov GT. Laparoscopic cholecystectomy: 700 consecutive cases. Int Surg 1995;80:296-8.

Owings MF, Kozak LJ. Ambulatory and inpatient procedures in the United States,1996. National Center for Health Statistics. Vital Health Stat, 1998;13:139.

Dasari BVM, Loan W, Carey DP. Spilled gallstones mimicking peritoneal metastasis. J Soc Laparoendoscop Surg 2009;13(1):73-6.

Amarin NS. Harmonic scalpel and clipless cholecystectomy. World J Laparoscopic Surg 2008; 1(2):6-8.

Vu T, Patel D, N. Marshall N. A clipless laproscopic cholecystectomy using the harmonic scalpel. ASGBI Oral presentation; Manchester on April19th 2007-benign hepatobilliary section

Redwan A. Single working instrument, double trocars, clipless cholecystectomy using harmonic scalpel, a feasible, safe and less invasive technique. Egyptian J Surg 2010; 29(1)40-7.

Helme S, Samdani T, Sinha P. Complications of spilled gallstones following laparoscopic cholecystectomy a case report and literature overview. J Med Case Reports 2009;8626-3.

Brockmann JG, Kocher T, Senninger NJ. Schurmann GM. Complications due to gallstones lost during laparoscopic cholecystectomy: An analysis of incidence, clinical course and management. Surg Endosc 2002; 16:1226-32.

Sathesh-Kumar, Saklani AP, Vinayagam R, Blackett RL. Spiled gallstones during laparoscopic cholecystectomy: A review of literature. Postgrad Med J 2004;80:77-9.

Zehetner J, Shamiyeh A, Wayand W. Lost gallstones in laparoscopic cholecystectomy: all possible complications. Am J Surg 2007; 193: 73-8.

Sasi W. Dissection by ultrasonic energery versus monopolar electrosurgical energy in laparoscopic cholecystectomy. J Soc Laparoendoscop Surg 2010;14(1):23-34.

Jain SK, Tanwar R, Kaza RCM, Agarwal P. A prospective randomized study of comparison of clipless cholecystectomy with conventional laparoscopic cholecystectomy. J Laparoendosc Adv Surg Tech A 2011;21(3):203-8.

Jan WA, Samad A, Khan SM, Haq MI, Ghani A. Early experience with Laparoscopic cholecystectomy. J Postgrad Med Inst 2005;19: 4: 433-7.

Chowbey PK, Bandyopadhyay SK, Khullar R, Sharma A, Soni V, Baijal V. Laparoscopic cholecystectomy- emerging horizons. BH J Appl Med Sci 2003;2:36-40.

Jorg Z, Andreas S, Wolfgang W. Lost gallstones in laparoscopic cholecystectomy: All possible complications. Am J Surg 2007;193: 73- 78.

El Nakeeb A, Askar W, El lithy R, Farid M. Clipless laparoscopic cholecystectomy using the harmonic scalpel in cirrhotic patients, a prospective randomized trial. Surg Endosc 2010; 24(10):2536-41.

.18. Vittimberga FJ, Foley DP, Meyers WC. Laparoscopic surgery and the systemic immune response. Ann Surg 1998; 227: 326-34.

Hackan DJ, Rostein OD. Host response to laparoscopic surgery: mechanisms and clinical correlates. Can J Surg 1998;41: 103-11.

Suh SW, Park JM, Lee SE, Choi YS. Accidental gallbladder perforation during laparoscopic cholecystectomy. Does It have an effect on the clinical outcomes? J Laparoendosc Adv Surg Tech 2012;22(1): 40-5.

Mohiuddin K, Nizami S, Fitzgibbons Jr RJ, Watson P, Memon B, Memon MA. Predicting iatrogenic gall bladder perforation during laparoscopic cholecystectomy: A multivariate logistic regression analysis of risk factors, ANZ J Surg 2006,76(3)130-2.

Bessa SS, Al-Fayoumi TA, Katri KM, Awad AT. Clipless laparoscopic cholecystectomy by ultrasonic dissection. J Laproendosc Adv Surg Tech A 2008; 18(4):593-8.

Zaidi AH, Haleem A, Rana S. Use of harmonic scalpel in laparoscopic cholecystectomy. Pak Armed Forces Med J 2011;61 (1):21-4.

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