Clipless Cholecystectomy: Broadening the Role of the Harmonic Scalpel

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Abstract
The ultrasonically activated (Harmonic) scalpel has proven to be an effective, efficient, and safe instrument for dissection and hemostasis in both open and laparoscopic surgical procedures. To date, the primary use of the Harmonic scalpel in laparoscopic cholecystectomies has been for the division of the cystic artery and liver bed dissection. Advancements in the Harmonic scalpel blade tip now provide for the reliable ultrasonic division and closure of the cystic duct. In a personal, prospective series involving 100 consecutive patients undergoing laparoscopic cholecystectomies, the Harmonic scalpel was used as the sole instrument for division of the cystic duct and artery as well as dissection of the liver bed. Two patients with large cystic ducts (over 5 mm) received an additional ductal ligature. No patients developed postoperative hemorrhage or bile leakage. The Harmonic scalpel provides complete hemobiliary stasis for most patients and is a safe alternative to standard clip or ligature closure of the cystic duct. Furthermore, there may be a cost savings inherent in a procedure utilizing a single disposable instrument.