title: Efficacy of electrocoagulation in sealing the cystic artery and cystic duct occluded with only one absorbable clip during laparoscopic cholecystectomy.
abstract: BACKGROUND
  Even though laparoscopic cholecystectomy (LC) emerged over 20 years ago, controversies persist with regard to the best method to ligate the cystic duct and artery. We proposed to assess the effectiveness and safety of electrocoagulation to seal the cystic artery and cystic duct after their occlusion with only one absorbable clip.
  
  
  METHODS
  We retrospectively compared the clinical data for 635 patients undergoing LC using electrocoagulation to seal the cystic artery and cystic duct that were occluded with only one absorbable clip (Group 1) and 728 patients undergoing LC using titanium clips (Group 2). In parallel, 30 rabbits randomized into six groups underwent cholecystectomy. After cystic duct ligation with absorbable or titanium clips, the animals were sacrificed 1, 3, or 6 months later, and intraabdominal adhesions were assessed after celiotomy.
  
  
  RESULTS
  The mean operative time was significantly shorter (41.6 versus 58.9 minutes, P<.01) in Group 1 than in Group 2. No cystic duct leaks occurred in any patients from Group 1, compared with seven leaks among the 728 (0.96%) patients from Group 2 (P<.05). The morbidity was significantly higher in Group 2 than in Group 1 (3.43% versus 1.58%). Mean intraoperative blood loss and hospitalization length were not significantly different between the two groups, and no deaths occurred in either group. In animal experiments, adhesion was tighter for absorbable than for titanium clips, but fibrous tissue encapsulation was thinner at the site of titanium clips.
  
  
  CONCLUSIONS
  Electrocoagulation of the cystic artery and cystic duct that were occluded with only one absorbable clip is safe and effective during LC. This approach is associated with shortened operative times and reduced leakage, compared with the standard method using metal clips.
authors.affiliation: 1 Department of General Surgery, The 117th Hospital of the People's Liberation Army , Hangzhou, Zhejiang, China .
authors.forename: Chang-Ping
authors.initials: CP
authors.lastname: Yang
authors.forename: Jin-Lin
authors.initials: JL
authors.lastname: Cao
authors.forename: Ren-Rong
authors.initials: RR
authors.lastname: Yang
authors.forename: Hong-Rong
authors.initials: HR
authors.lastname: Guo
authors.forename: Zhao-Hui
authors.initials: ZH
authors.lastname: Li
authors.forename: Hai-Ying
authors.initials: HY
authors.lastname: Guo
authors.forename: Yin-Can
authors.initials: YC
authors.lastname: Shao
authors.forename: Gui-Bao
authors.initials: GB
authors.lastname: Liu
mesh_terms: D000328:Adult; D000818:Animals; D001158:Arteries / Q000601:surgery*; D001649:Bile Duct Diseases / Q000601:surgery*; D017081:Cholecystectomy, Laparoscopic / Q000295:instrumentation / Q000379:methods*; D003549:Cystic Duct / Q000601:surgery*; D003972:Diathermy; D004564:Electrocoagulation / Q000379:methods*; D005260:Female; D005704:Gallbladder / Q000601:surgery; D006801:Humans; D007902:Length of Stay; D008026:Ligation / Q000379:methods*; D008297:Male; D061646:Operative Time; D011817:Rabbits; D012189:Retrospective Studies; D013525:Surgical Instruments