Dissection Procedures in Laparoscopic Cholecystectomy
Dissection Procedures in Laparoscopic Cholecystectomy
This viewpoint from Albert Lowenfels, MD, offers commentary on important clinical research in the field of general surgery.
Cengiz Y, Janes A, Grehn A, Israelsson LA
Br J Surg. 2005;92:810-813
How important is technique in performing laparoscopic cholecystectomy? In this randomized study of 80 Swedish patients, the study authors compared traditional (apex first) dissection performed by electrocautery with a fundus-first approach with an ultrasonic scalpel. Both groups were similar with respect to age, sex, and the presence or absence of cholecystitis. Duration of surgery was shorter in the ultrasound fundus-first group than in the traditional group; pain was less, and the need for overnight hospitalization was reduced. The study authors thought that the fundus-first procedure would be safer than the traditional approach, but there were no deaths or bile duct injuries in either group.
The study findings imply that, for this common operation, technique counts. Fundus-first procedures performed with the ultrasonic knife were shorter; patients had less pain and nausea; and the need for overnight hospitalization was reduced. It will require a much larger study to decide whether this approach is safer than the traditional approach.
Abstract
Randomized Trial of Traditional Dissection With Electrocautery Versus Ultrasonic Fundus-First Dissection in Patients Undergoing Laparoscopic Cholecystectomy
This viewpoint from Albert Lowenfels, MD, offers commentary on important clinical research in the field of general surgery.
Cengiz Y, Janes A, Grehn A, Israelsson LA
Br J Surg. 2005;92:810-813
Study Summary
How important is technique in performing laparoscopic cholecystectomy? In this randomized study of 80 Swedish patients, the study authors compared traditional (apex first) dissection performed by electrocautery with a fundus-first approach with an ultrasonic scalpel. Both groups were similar with respect to age, sex, and the presence or absence of cholecystitis. Duration of surgery was shorter in the ultrasound fundus-first group than in the traditional group; pain was less, and the need for overnight hospitalization was reduced. The study authors thought that the fundus-first procedure would be safer than the traditional approach, but there were no deaths or bile duct injuries in either group.
Viewpoint
The study findings imply that, for this common operation, technique counts. Fundus-first procedures performed with the ultrasonic knife were shorter; patients had less pain and nausea; and the need for overnight hospitalization was reduced. It will require a much larger study to decide whether this approach is safer than the traditional approach.
Abstract
