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October 1992

The Ultrasonic Dissector Facilitates Laparoscopic Cholecystectomy

Author Affiliations

From the Department of Surgery, University of California, San Francisco (Drs Wetter and Way); the Department of Surgery, Kaiser Hospital and the University of Hawaii, Honolulu (Dr Payne and Ms Podoll); and the Department of Surgery, Humana Hospital, Aurora, Colo (Dr Kirshenbaum and Mr Bachinsky). The authors have no financial interest in Valleylab Inc, Boulder, Colo. Neither they nor members of their families have been paid stipends as employees or consultants by the firm.

Arch Surg. 1992;127(10):1195-1199. doi:10.1001/archsurg.1992.01420100053009

• The ultrasonic dissector disrupts tissues in proportion to their fluid content by ultrasonically induced cavitational forces. Since sturdy tissues are spared, the instrument tends to follow tissue planes and to dissect fat and other soft tissues selectively. We performed a prospective, randomized, controlled trial in 73 patients comparing the safety and efficacy of a prototype ultrasonic dissector with that of electrosurgery and laser during laparoscopic cholecystectomy. Randomization was as follows: ultrasonic dissector, 37 patients; electrosurgery, 21 patients; and laser, 15 patients. The results were not different with respect to patient characteristics, amount of blood loss, technical difficulties, length of hospital stay, or return to work. Subjectively, the ultrasonic dissector was thought to be of special value in isolating the hilar structures, particularly when they were edematous or embedded in fat. The ultrasonic dissector disintegrated the fat, which was rapidly cleared up the suction channel, allowing the cystic duct and artery to be bared with less risk of injury. We concluded that the ultrasonic dissector has unique attributes that contribute to the ease and safety of laparoscopic cholecystectomy.

(Arch Surg. 1992;127:1195-1199)