Ultrasonic energy vs monopolar electrosurgery in laparoscopic cholecystectomy: influence on the postoperative systemic immune response.
BACKGROUND
The influence of surgical operations on the systemic immune response is proportional to the degree of trauma. Ultrasonic surgery can dissect structures and divide vessels by the effect produced by vibrations in the tissues. It is believed to be less traumatic than the more commonly used monopolar electrosurgery. This randomized study compares the systemic immune response after laparoscopic cholecystectomy performed using either ultrasonic energy or monopolar electrosurgery.


METHODS
Eighteen patients scheduled for elective laparoscopic cholecystectomy were randomly assigned to treatment using either a harmonic scalpel and clips or monopolar electrosurgery and clips. Postoperative inflammatory response was assessed via changes in the white blood cell count and levels of C-reactive protein. Postoperative immune function was assessed by measuring monocyte HLA-DR expression.


RESULTS
Both the harmonic scalpel and the use of monopolar electrosurgery resulted in activation of the systemic immune response. No significant differences between the two groups were observed.


CONCLUSIONS
The harmonic scalpel and monopolar electrosurgery are equally traumatic in terms of activation of the systemic immune response.
Sietses
C
C
Department of Surgery, Faculty of Medicine and Academic Hospital Vrije Universiteit, Amsterdam, The Netherlands.
Eijsbouts QAJ
von Blomberg
B M
BM
Cuesta
M A
MA
D002097:C-Reactive Protein / Q000032:analysis; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D002769:Cholelithiasis / Q000601:surgery; D004598:Electrosurgery / Q000379:methods*; D006684:HLA-DR Antigens / Q000032:analysis; D006801:Humans; D007111:Immunity, Cellular; D007958:Leukocyte Count; D014465:Ultrasonics
D006684:HLA-DR Antigens; D002097:C-Reactive Protein