title: Is LigaSure a safe cystic duct sealer? An ex vivo study.
abstract: BACKGROUND
  To compare the efficacy and safety of both mechanical methods (clips) and electrosurgical instruments, harmonic scalpel (HS) and LigaSure (LS), for securing the cystic duct during laparoscopic cholecystectomy (LC).
  
  
  METHODS
  During the study period from October 2010 to October 2012, 458 patients with gallbladder stones underwent LC. A total of 38 patients were excluded from the study for different reasons. The gallbladder was excised laparoscopically through the traditional method. The gallbladder specimens of the patients were divided into three equal groups randomly, and the distal part of the cystic duct was sealed ex vivo using ligaclips (Group A), HS (Group B), and LS (Group C). The gallbladders were then connected to a pneumatic tourniquet device and we very gradually increased the pressure with air. The bursting pressure of the cystic duct (CDBP) was measured and differences between the three groups were calculated.
  
  
  RESULTS
  The mean CDBP was 329.7 ± 38.8 mmHg in the ligaclip group, 358.0 ± 33.1 mmHg in the HS group, and 219.7 ± 41.2 mmHg in the LS group. A comparison of the mean CDBP between the groups indicated the superiority of HS over ligaclip and LS. CDBP was significantly higher in the ligaclips group compared with the LS group (p <0.001). HS and ligaclips were found to be safe sealers as their mean CDBP was found to be higher (>195 mmHg) than the maximum common bile duct pressure, whereas for LS the CDBP range was 150-297 mmHg, indicating that it is not safe for sealing.
  
  
  CONCLUSIONS
  HS is a safe alternative to clips. In fact, it was even safer than clips. By contrast, LS is not safe for cystic duct sealing.
authors.affiliation: Department of General Surgery, Mansoura University Hospital, Mansoura, Egypt.
authors.forename: Emad
authors.initials: E
authors.lastname: Abdallah
authors.affiliation: Department of General Surgery, Mansoura University Hospital, Mansoura, Egypt. Electronic address: surg_latif@hotmail.com.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abd Ellatif
authors.affiliation: Department of General Surgery, Mansoura University Hospital, Mansoura, Egypt.
authors.forename: Saleh
authors.initials: S
authors.lastname: El Awady
authors.affiliation: Department of General Surgery, Mansoura University Hospital, Mansoura, Egypt.
authors.forename: Alaa
authors.initials: A
authors.lastname: Magdy
authors.affiliation: Department of General Surgery, Mansoura University Hospital, Mansoura, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Youssef
authors.affiliation: Department of General Surgery, Mansoura University Hospital, Mansoura, Egypt.
authors.forename: Waleed
authors.initials: W
authors.lastname: Thabet
authors.affiliation: Department of General Surgery, Mansoura University Hospital, Mansoura, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Lotfy
authors.affiliation: Department of General Surgery, Mansoura University Hospital, Mansoura, Egypt.
authors.forename: Ayman
authors.initials: A
authors.lastname: Elshobaky
authors.affiliation: Department of General Surgery, Mansoura University Hospital, Mansoura, Egypt.
authors.forename: Mosaad
authors.initials: M
authors.lastname: Morshed
mesh_terms: D017081:Cholecystectomy, Laparoscopic / Q000295:instrumentation* / Q000379:methods; D003549:Cystic Duct / Q000601:surgery*; D004598:Electrosurgery / Q000295:instrumentation*; D005260:Female; D042882:Gallstones / Q000601:surgery*; D006801:Humans; D066298:In Vitro Techniques; D008297:Male; D011446:Prospective Studies; D059708:Ultrasonic Surgical Procedures / Q000295:instrumentation*
keywords: LigaSure; bile leakage; clips; harmonic scalpel; laparoscopic cholecystectomy