Ramos Almino Cardoso, Ramos Manoela Galvão, Galvão-Neto Manoel dos Passos, Marins Josemberg, Bastos Eduardo Lemos de Souza, Zundel Natan
Gastro Obeso Center.
Federal University of Pernambuco.
Arq Bras Cir Dig. 2015;28(1):53-6. doi: 10.1590/S0102-67202015000100014.
In traditional laparoscopic cholecistectomy, the cystic duct and artery are commonly closed by metallic clips just before their division. Although the placement of these clips for occluding cystic artery and duct can be considered safe, biliary leaks and bleeding may occur especially by its dislodgement.
To report a prospective case-series in total clipless cholecystectomy by means of harmonic shears for closure and division of the artery and cystic duct as well removal of the gallbladder from the liver.
Was evaluate a series of 125 patients who underwent laparoscopic cholecystectomy where the sealing and division of cystic artery and duct was carried out only by harmonic shears. The intact extracted gallbladder was submitted to a reverse pressure test for assessment of the technique safety by means of CO2 insuflation.
The most common indication for surgery was gallstones. The mean operative time was 26 min and all gallbladders were dissected intact from the liver bed. There was no mortality and the overall morbidity rate was 0.8% with no hemorrhage or leaks. The reverse pressure test showed that all specimens support at least 36-mmHg of pressure without leaking.
The harmonic shears is effective and safe in laparoscopic cholecystectomy as a sole instrument for sealing and division of the artery and cystic duct. The main advantages could be related to the safety and decreased operative time.
在传统的腹腔镜胆囊切除术中，胆囊管和动脉通常在离断前用金属夹夹闭。尽管使用这些夹子夹闭胆囊动脉和胆囊管可被认为是安全的，但尤其是夹子移位时，可能会发生胆漏和出血。
报告一系列前瞻性病例，采用超声刀离断动脉和胆囊管并将胆囊从肝脏上切除，完成完全无夹胆囊切除术。
评估125例行腹腔镜胆囊切除术的患者，术中仅用超声刀封闭和离断胆囊动脉和胆囊管。完整取出的胆囊通过二氧化碳充气进行反向压力测试，以评估该技术的安全性。
最常见的手术指征是胆结石。平均手术时间为26分钟，所有胆囊均完整地从肝床分离。无死亡病例，总体发病率为0.8%，无出血或胆漏。反向压力测试显示，所有标本至少能承受36mmHg的压力而不渗漏。
在腹腔镜胆囊切除术中，超声刀作为封闭和离断动脉及胆囊管的唯一器械是有效且安全的。其主要优点可能与安全性和缩短手术时间有关。
