Laser vs electrosurgery in laparoscopic cholecystectomy. A prospective randomized trial
B. M. Bordelon, K. A. Hobday and J. G. Hunter
Department of Surgery, University of Utah School of Medicine, Salt Lake City 84132.
While much of the clamor over the optimal instrument for dissection of the
gallbladder from the liver bed has died, there remain no prospective
comparative data concerning this issue. We undertook a prospective
randomized trial comparing the contact neodymium:YAG laser with monopolar
electrosurgical dissection in 100 patients undergoing laparoscopic
cholecystectomy. Electrosurgical dissection was performed with an "L" hook
and spatula electrodes at 25 W coagulation current. Neodymium:YAG laser
dissection was performed with a 1200-microns contact tip at 15 W continuous
beam. Mean (+/- SD) gallbladder dissection time was 19.2 +/- 8.5 minutes
with electrosurgery compared with 23.6 +/- 9.6 minutes with the laser.
Estimated blood loss was significantly less in the electrosurgery-treated
group. In six instances, laser malfunction or fiber fragmentation
necessitated completing the dissection with electrosurgery. We conclude
that electrosurgery appears to have significant advantages for dissection
of the gallbladder during laparoscopic cholecystectomy.
