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Comparison of Different Cystic Duct Closure Methods in Laparoscopic Cholecystectomy: Silk Suture, Surgical Clip, Harmonic Scalpel and PlasmaKinetic

M. Tahir Ozer, Huseyin Sinan, Zafer Kilbas, A. Kagan Coskun, Armagan Gunal, Sezai Demirbas, Murat Kantarcioglu, A. Ihsan Uzar, Orhan Kozak.

Abstract
Background: Harmonic Scalpel and PlasmaKinetic have become popular with the promise of quick and effective vascular control. Their excellent outcomes encouraged surgeons to use these instruments for closure of the bile ducts with little or no data, establishing their efficacy or safety. Aim: The aim of this experimental study was to compare the safety and feasibility of different cystic duct closure methods (suture ligation, clip application, Harmonic Scalpel and PlasmaKinetic).
Methods: Sixty non-perforated gallbladders extracted during laparoscopic cholecystectomy were studied in this ex vivo study. Gallbladders were randomly divided into four groups and the distal end of cystic ducts remaining with sacs was reclosed by one of the four different methods. By means of a catheter, air insufflation was administered into gallbladders with a pressure-controlled pump. Bursting pressure and lateral thermal injury were measured for each group, and groups were compared with each other.
Results: In the Harmonic Scalpel group, a 1.4 mm lateral thermal injury was detected, while it was 1.6 mm in the PlasmaKinetic group. But, in terms of bursting pressure, there was not a statistically significant difference between the groups.
Conclusion: Cystic duct closure with the new devices may be an alternative to surgical clips. Further trials are needed to evaluate the feasibility and safety of PlasmaKinetic usage in the clinical setting.

Key words: Laparoscopic cholecystectomy, ultrasonically activated devices, vessel sealing systems, cystic duct ligation, bile leakage



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