title: Total clipless cholecystectomy by means of harmonic sealing.
abstract: BACKGROUND
  In traditional laparoscopic cholecistectomy, the cystic duct and artery are commonly closed by metallic clips just before their division. Although the placement of these clips for occluding cystic artery and duct can be considered safe, biliary leaks and bleeding may occur especially by its dislodgement.
  
  
  OBJECTIVE
  To report a prospective case-series in total clipless cholecystectomy by means of harmonic shears for closure and division of the artery and cystic duct as well removal of the gallbladder from the liver.
  
  
  METHODS
  Was evaluate a series of 125 patients who underwent laparoscopic cholecystectomy where the sealing and division of cystic artery and duct was carried out only by harmonic shears. The intact extracted gallbladder was submitted to a reverse pressure test for assessment of the technique safety by means of CO2 insuflation.
  
  
  RESULTS
  The most common indication for surgery was gallstones. The mean operative time was 26 min and all gallbladders were dissected intact from the liver bed. There was no mortality and the overall morbidity rate was 0.8% with no hemorrhage or leaks. The reverse pressure test showed that all specimens support at least 36-mmHg of pressure without leaking.
  
  
  CONCLUSIONS
  The harmonic shears is effective and safe in laparoscopic cholecystectomy as a sole instrument for sealing and division of the artery and cystic duct. The main advantages could be related to the safety and decreased operative time.
authors: Gastro Obeso Center.
authors: Almino Cardoso
authors: AC
authors: Ramos
authors: Gastro Obeso Center.
authors: Manoela Galvão
authors: MG
authors: Ramos
authors: Gastro Obeso Center.
authors: Manoel dos Passos
authors: Mdos P
authors: Galvão-Neto
authors: Federal University of Pernambuco.
authors: Josemberg
authors: J
authors: Marins
authors: Gastro Obeso Center.
authors: Eduardo Lemos de Souza
authors: EL
authors: Bastos
authors: Florida International University, Miami, USA.
authors: Natan
authors: N
authors: Zundel
mesh_terms: D000328:Adult; D000368:Aged; D017081:Cholecystectomy, Laparoscopic / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D059708:Ultrasonic Surgical Procedures / Q000295:instrumentation; D055815:Young Adult