Sasi Walid
Department of Surgery, Our Lady of Lourdes Hospital Drogheda, Ireland.
Surg Technol Int. 2010 Apr;19:70-8.
Electrocautery remains the main energy form used for dissection in laparoscopic cholecystectomy. However, due to its many risks the search continues for safer and more efficient forms of energy. This chapter assesses the outcomes of dissection using ultrasonic energy as compared to monopolar electrocautery during laparoscopic cholecystectomy. Studies included are trials of prospectively randomized adult patients with symptomatic gallstone disease subject either ultrasonic or monopolar electrocautery dissection during laparoscopic cholecystectomy. Seven trials were included in this review, with a total patient number of 695 randomized to two dissection methods: 340 in the electrocautery group and 355 in the ultrasonic group. Ultrasonic dissection is shown to be superior to monopolar electrocautery in laparoscopic cholecystectomy. Disadvantages include a difficult maneuvering technique and overall cost. Appropriate training programs may be implemented to overcome the first disadvantage, and it might be argued that given the combined cost of factors associated with standard clip and cautery technique, cost issues may be outweighed by the benefits of ultrasonic dissection. However, this necessitates further cost-benefit analysis.
电灼术仍然是腹腔镜胆囊切除术中用于解剖的主要能量形式。然而，由于其存在诸多风险，人们仍在继续寻找更安全、更有效的能量形式。本章评估了在腹腔镜胆囊切除术中使用超声能量进行解剖与单极电灼术相比的结果。纳入的研究是对有症状胆结石疾病的成年患者进行前瞻性随机试验，这些患者在腹腔镜胆囊切除术中接受超声或单极电灼术解剖。本综述纳入了7项试验，共有695例患者随机分为两种解剖方法：电灼术组340例，超声组355例。结果表明，在腹腔镜胆囊切除术中，超声解剖优于单极电灼术。其缺点包括操作技术难度大以及总体成本高。可以实施适当的培训计划来克服第一个缺点，并且可以认为，考虑到与标准夹闭和电灼术技术相关的综合成本因素，超声解剖的益处可能会超过成本问题。然而，这需要进一步的成本效益分析。
