title: Improved outcome after laparoscopic cholecystectomy with ultrasonic dissection: a randomized multicenter trial.
abstract: BACKGROUND
  In conventional laparoscopic cholecystectomy, dissection with electrocautery starts at the triangle of Calot. In a randomized single-center trial, the fundus-first method (dome down) using ultrasonic dissection was faster, involved less pain or nausea, and had a shorter postoperative sick leave. This may relate to the fundus-first method or to the ultrasonic dissection.
  
  
  METHODS
  In a multicenter trial, 243 elective patients were randomized to conventional laparoscopic cholecystectomy using electrocautery (n = 85) or the fundus-first method using either electrocautery (n = 81) or ultrasonic dissection (n = 77).
  
  
  RESULTS
  The fundus-first method had a shorter operating time with ultrasonic dissection (58 min) than with electrocautery (74 min; p = 0.002). The fundus-first method using ultrasonic dissection compared with electrocautery or the conventional method produced less blood loss (12 vs. 53 or 36 ml; p < 0.001) and fewer gallbladder perforations (26% vs. 46% or 49%; p = 0.005). Also, the pain and nausea scores at 4 and 6 h were lower, and the sick leave was shorter (6.1 vs. 9.4 and 9 days, respectively; p < 0.001).
  
  
  CONCLUSIONS
  The fundus-first method using ultrasonic dissection is associated with less blood loss, fewer gallbladder perforations, less pain and nausea, and shorter sick leave than the conventional and fundus-first method using electrocautery. The difference seems related to the use of ultrasonic dissection.
authors.affiliation: Department of Surgery, Sundsvall Hospital, 851 86 Sundsvall, Sweden. Yucel.Cengiz@lvn.se
authors.forename: Yucel
authors.initials: Y
authors.lastname: Cengiz
authors.forename: Jan
authors.initials: J
authors.lastname: Dalenbäck
authors.forename: Gunnar
authors.initials: G
authors.lastname: Edlund
authors.forename: Leif A
authors.initials: LA
authors.lastname: Israelsson
authors.forename: Arthur
authors.initials: A
authors.lastname: Jänes
authors.forename: Mats
authors.initials: M
authors.lastname: Möller
authors.forename: Anders
authors.initials: A
authors.lastname: Thorell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D017081:Cholecystectomy, Laparoscopic; D002764:Cholecystitis / Q000601:surgery*; D004210:Dissection / Q000295:instrumentation; D004564:Electrocoagulation / Q000379:methods*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D012307:Risk Factors; D018582:Sick Leave / Q000706:statistics & numerical data; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome; D014464:Ultrasonic Therapy
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