Skip to main content

Advertisement

SpringerLink
Log in

Outcomes of laparoscopic cholecystectomy done with surgical energy versus done without surgical energy: a prospective-randomized control study

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Objective

Laparoscopic cholecystectomy (LC), a gold standard procedure can be done without energized dissection (ED). We did a randomized study for the outcomes of LC done with ED or without ED, i.e., with cold dissection (CD).

Methods and Procedures

At a tertiary level institution, open-ended prospective-randomized control study was conducted between September 2008 and June 2013. Consecutive, unselected, consenting candidates for LC were enrolled following standard ethics, informed consent, anesthesia, and clinical pathway protocol. They were allocated to control group (LC with ED) or study group (LC with CD, as per our published technique with the option for rescue ED). The study points were based upon Clavien–Dindo grading of postoperative complications. They were either, peri-operative events potentially affecting, hospital stay (Grade I) or Grade II–V, e.g., peri-operative hemodynamic instability, needing intervention/blood transfusion, injury to biliary ducts/hollow viscous, postoperative biliary leak, postoperative re-intervention, re-hospitalization, mortality, and any adverse event during a 90-day follow-up period. The data were prospectively collected in an integrated “hospital information system” that could be retrieved only by independent external coordinators.

Results

Demographics, co-morbidities, and gallbladder inflammation profile of the control group (n = 361) and study group (n = 384) were comparable. There was no rescue ED usage in the study group. Hospital stay (Grade I adverse outcome dependent) was longer, i.e., 1.6 ± 1.03 in the control versus 1.35 ± 1.2 days in the study group (p < 0.001). Grade II–IV complications were significantly more (p < 0.009) in control group. There was one common bile duct (CBD) injury in each group. The index bilio-enteric anastomosis for CBD injury in control group failed and needed a revision with multiple interventions. There was one grade V adverse outcome, i.e., mortality in the control group.

Conclusion

Avoiding the use of ED in LC is associated with better outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Agarwal BB, Chintamani C (2011) Reminder of the metrics of endosurgical innovation. Arch Surg 146:1108

    Article  PubMed  Google Scholar 

  2. Agarwal BB, Mahajan KC (2010) Laparoscopic biliary tract injury prevention: zero tolerance, error free performance. Surg Endosc 24:728–729

    Article  PubMed  Google Scholar 

  3. Ergina PL, Cook JA, Blazeby JM, Boutron I, Clavien PA, Reeves BC, Seiler CM; Balliol Collaboration, Altman DG, Aronson JK, Barkun JS, Campbell WB, Cook JA, Feldman LS, Flum DR, Glasziou P, Maddern GJ, Marshall JC, McCulloch P, Nicholl J, Strasberg SM, Meakins JL, Ashby D, Black N, Bunker J, Burton M, Campbell M, Chalkidou K, Chalmers I, de Leval M, Deeks J, Grant A, Gray M, Greenhalgh R, Jenicek M, Kehoe S, Lilford R, Littlejohns P, Loke Y, Madhock R, McPherson K, Rothwell P, Summerskill B, Taggart D, Tekkis P, Thompson M, Treasure T, Trohler U, Vandenbroucke J (2009) Challenges in evaluating surgical innovation. Lancet 374:1097–1104

  4. Agarwal KA, Tripathi CD, Agarwal BB, Saluja S (2011) Efficacy of turmeric (curcumin) in pain and postoperative fatigue after laparoscopic cholecystectomy: a double-blind, randomized placebo-controlled study. Surg Endosc 25:3805–3810

    Article  PubMed  Google Scholar 

  5. Agarwal BB (2011) Do dietary spices impair the patient-reported outcomes for stapled hemorrhoidopexy? A randomized controlled study. Surg Endosc 25:1535–1540

    Article  PubMed  Google Scholar 

  6. Agarwal BB (2010) Energized dissection, energized hemostasis. Arch Surg 145:1021

    Article  PubMed  Google Scholar 

  7. Agarwal BB, Agarwal S (2007) The man-machine interface, a paradox of technology. Is the black box (BB) concept an angel or a demon? Surg Endosc 21:1680

    Article  PubMed  Google Scholar 

  8. Law KS, Lyons SD (2013) Comparative studies of energy sources in gynecologic laparoscopy. J Minim Invasive Gynecol 20:308–318

    Article  PubMed  Google Scholar 

  9. Agarwal BB (2007) Are energy sources required in laparoscopic cholecystectomy? Or should they be standby? Surg Endosc 21:1042

    Article  PubMed  CAS  Google Scholar 

  10. Agarwal BB, Gupta M, Agarwal S, Mahajan KC (2007) Laparoscopic cholecystectomy without using any energy source. J Laparoendosc Adv Surg Tech A 17:296–301

    Article  PubMed  Google Scholar 

  11. Agarwal BB, Gupta M, Agarwal S, Mahajan K (2007) Anatomical footprint for safe laparoscopic cholecystectomy without using any energy source: a modified technique. Surg Endosc 21:2154–2158

    Article  PubMed  CAS  Google Scholar 

  12. Agarwal BB (2010) Results of laparoscopic cholecystectomy without energized dissection: a prospective study. Int J Surg 8:167–172

    Article  PubMed  Google Scholar 

  13. Agarwal BB, Sinha B, Mahajan KC (2010) Double blind randomized control study-outcomes of laparoscopic cholecystectomy (without using energy source) performed by a trainee or a consultant. 17th International Congress of the European Association for Endoscopic Surgery (EAES) Prague, Czech Republic, 17–20 June 2009. Surg Endosc 24:S37

  14. Agarwal BB, Jayaraman L, Mishra A, Sarangi R, Mahajan KC (2010) Clinical outcomes of laparoscopic cholecystectomy (without energised dissection) Performed by a basic surgical trainee or a consultant-double blind randomized control Study. 2010 Scientific Session of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) National Harbor, Maryland, USA, 14–17 April 2010. Surg Endosc 24:S580

  15. Agarwal BB, Gupta MK, Agarwal S, Mahajan KC (2007) Avoiding any energy source for a safe & better laparoscopic Cholecystectomy. 2007 Scientific Session of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Las Vegas, Nevada, USA, 18–22 April 2007. Surg Endosc 21:S443

  16. Agarwal BB, Agarwal S, Gupta MK, Agarwal N, Agarwal D, Goyal K, Saluja S, Mahajan KC,Agarwal KA, Pandey H (2013) Evaluation of avascular ‘‘holy plane’’ based cold dissection technique in consecutive unselected laparoscopic cholecystectomies: results of 7 year experience. 2013 Scientific Session of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Baltimore, Maryland, USA, 17–20 April 2013. Surg Endosc 27:S396

  17. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed  PubMed Central  Google Scholar 

  18. Sankaranarayanan G, Resapu RR, Jones DB, Schwaitzberg S, De S (2013) Common uses and cited complications of energy in surgery. Surg Endosc 27:3056–3072

    Article  PubMed  PubMed Central  Google Scholar 

  19. Feldman LS, Fuchshuber P, Jones DB, Mischna J, Schwaitzberg SD, Force FT (2012) Surgeons don’t know what they don’t know about the safe use of energy in surgery. Surg Endosc 26:2735–2739

    Article  PubMed  Google Scholar 

  20. Janssen IM, Swank DJ, Boonstra O, Knipscheer BC, Klinkenbijl JH, van Goor H (2003) Randomized clinical trial of ultrasonic versus electrocautery dissection of the gallbladder in laparoscopic cholecystectomy. Br J Surg 90:799–803

    Article  PubMed  CAS  Google Scholar 

  21. Heald RJ (1988) The ‘Holy Plane’ of rectal surgery. J R Soc Med 81:503–508

    PubMed  CAS  PubMed Central  Google Scholar 

  22. Agarwal BB (2008) Journey of the carbon-literate and climate-conscious endosurgeon having a head, heart, hands, and holistic sense of responsibility. Surg Endosc 22:2539–2540

    Article  PubMed  Google Scholar 

  23. Agarwal BB, Chintamani AK, Goyal K, Mahajan KC (2012) Innovations in Endosurgery — Journey into the Past of the Future. To Ride the SILS Bandwagon or Not? Indian J Surg 74:234–241

    Article  PubMed  PubMed Central  Google Scholar 

  24. Fingerhut A, Dziri C, Garden OJ, Gouma D, Millat B, Neugebauer E, Paganini A, Targarona E (2013) ATOM, the all-inclusive, nominal EAES classification of bile duct injuries during cholecystectomy. Surg Endosc 27:4608–4619

    Article  PubMed  CAS  Google Scholar 

  25. Agarwal BB (2009) Patient safety in laparoscopic cholecystectomy. Arch Surg 144:979

    Article  PubMed  Google Scholar 

  26. Strasberg SM, Helton WS (2011) An analytical review of vasculobiliary injury in laparoscopic and open cholecystectomy. HPB (Oxford) 13:1–14

    Article  Google Scholar 

  27. Mahabaleshwar V, Kaman L, Iqbal J, Singh R (2012) Monopolar electrocautery versus ultrasonic dissection of the gallbladder from the gallbladder bed in laparoscopic cholecystectomy: a randomized controlled trial. Can J Surg 55:307–311

    Article  PubMed  PubMed Central  Google Scholar 

  28. Agarwal BB (2008) Outcomes in laparoscopic cholecystectomy (LS) done with or without using energy sources (ES): results of a Prospective randomized controlled Study. 2008 Scientific Session of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Philadelphia, Pennsylvania, USA, 9–12 April 2008. Surg Endosc 22:S224

  29. Quinn M, Suttie S, Li A, Ravindran R (2011) Are blood group and save samples needed for cholecystectomy? Surg Endosc 25:2505–2508

    Article  PubMed  Google Scholar 

  30. Feldman LS, Delaney CP (2014) Laparoscopy Plus Enhanced Recovery: optimizing the Benefits of MIS Through SAGES ‘SMART’ Program. Surg Endosc 28:1403–1406

    Article  PubMed  Google Scholar 

  31. Büchler MW, Diener MK, Weitz J (2011) Scientific evaluation of modern clinical research: we need a new currency! Langenbecks Arch Surg 396:937–939

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors are grateful to Ms Pooja and Ms Ramneek for preparating the manuscript. This work is an outcome of our team selflessly supported by the department of anaesthesia and the paramedical team led by surgical technician Pankaj Dayal & Sister Harpreet Kaur.

Disclosures

Brij B Agarwal, Karan Goyal, Nayan Agarwal, Krishna A Agarwal, Juhil D Nanavati, Sheikh T Mustafa, Kumar Manish, Himanshu Pandey, Shruti Sharma, Kamran Ali, Manish K Gupta, Satish Saluja, and Sneh Agarwal have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Department of General and Laparoscopic Surgery, Ganga Ram Institute of Post Graduate Medical Education and Research (GRIPMER), New Delhi, India

    Brij B. Agarwal, Karan Goyal, Juhil D. Nanvati, Kumar Manish, Himanshu Pandey, Shruti Sharma, Kamran Ali, Sheikh T. Mustafa & Manish K. Gupta

  2. University College of Medical Sciences, New Delhi, India

    Nayan Agarwal

  3. Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India

    Krishna A. Agarwal

  4. Department of Academics, Ganga Ram Institute of Post Graduate Medical Education and Research (GRIPMER), New Delhi, India

    Satish Saluja

  5. Department of Anatomy, Lady Hardinge Medical College, New Delhi, India

    Sneh Agarwal

Authors
  1. Brij B. Agarwal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nayan Agarwal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Krishna A. Agarwal
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Karan Goyal
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Juhil D. Nanvati
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kumar Manish
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Himanshu Pandey
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Shruti Sharma
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Kamran Ali
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Sheikh T. Mustafa
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Manish K. Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Satish Saluja
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Sneh Agarwal
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Brij B. Agarwal.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Agarwal, B.B., Agarwal, N., Agarwal, K.A. et al. Outcomes of laparoscopic cholecystectomy done with surgical energy versus done without surgical energy: a prospective-randomized control study. Surg Endosc 28, 3059–3067 (2014). https://doi.org/10.1007/s00464-014-3579-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-014-3579-6

Keywords

Search

Navigation