Comparative Outcomes of Laparoscopic Clipless Cholecystectomy Using Harmonic Scalpel versus Conventional Technique with Liga Clips: A Clinical Study

Abstract

Gallstone disease is an increasingly prevalent global health issue. Laparoscopic cholecystectomy, a minimally invasive surgical approach, ensures smaller incisions and quicker recovery. The Harmonic scalpel offers a safe and efficient tool for dissection and haemostasis, but conflicting evidence regarding its efficacy exists in the literature. Objective: To compare intraoperative and postoperative outcomes of clipless laparoscopic cholecystectomy using the Harmonic scalpel versus conventional clip-based cholecystectomy for managing gallbladder stones. Methods: A randomized controlled trial was conducted at the Department of General Surgery, Nishtar Medical University/Hospital, Multan, over six months, from January 1, 2025, to June 30, 2025. A total of 120 patients were enrolled via non-probability consecutive sampling and randomly divided into two equal groups. Group A underwent clipless cholecystectomy with the Harmonic scalpel, while Group B underwent conventional clip-based cholecystectomy. Outcomes measured included operative time, gallbladder perforation, intraoperative blood loss, postoperative pain (Visual Analogue Scale), bile leakage, and wound infection. Follow-up assessments were conducted at 24 hours, 3 days, and 7 days postoperatively. Data were recorded on a standardized proforma and analyzed using SPSS 26.0. Results: Patients in the Harmonic scalpel group (Group A) had a mean age of 44.12±13.84 years, while the conventional group (Group B) had a mean age of 47.08±13.16 years. The Harmonic scalpel group demonstrated significantly shorter operative times (49.82±6.06 min vs. 55.43±9.39 min, p<0.001), reduced intraoperative blood loss (65.58±8.94 ml vs. 74.00±14.79 ml, p<0.001), and fewer complications, including gallbladder perforation (1.7% vs. 11.7%, p<0.05), postoperative pain (15% vs. 31.7%, p<0.05), bile leakage (8.3% vs. 21.7%, p<0.05), and wound infections (5.0% vs. 16.7%, p<0.05). Conclusion: The Harmonic scalpel demonstrates superior outcomes and fewer complications compared to conventional methods in laparoscopic cholecystectomy. Its adoption may enhance surgical practices and improve patient satisfaction.