title: Day-care laparoscopic cholecystectomy with diathermy hook versus fundus-first ultrasonic dissection: a randomized study.
abstract: To examine the impact of day-care laparoscopic cholecystectomy (LC) with ultrasonic scissors dissection versus diathermy hook dissection method in a randomized setting.
  
  
  
  From April 2012 to September 2014, a total of 169 elective day-care patients were randomized to undergo either laparoscopic cholecystectomy with ultrasonic scissors using fundus-first approach (n = 88) or diathermy hook dissection starting from the triangle of Calot (n = 79). Main measures of outcome were operative time, same-day discharge and intraoperative complications. Secondary outcome measures were postoperative pain (numeric rating scale), postoperative nausea and vomiting (PONV), readmissions and 30-day morbidity.
  
  
  
  Median operative time was similar in the ultrasonic dissection and diathermy hook dissection groups (45 vs 45 min, p = 0.95). Same-day discharge was possible in 77 patients (87 %) in the ultrasonic dissection group and in 69 patients (87 %) in the diathermy group, p = 0.98. Intraoperative gallbladder perforations, mean intraoperative bleeding, postoperative pain and PONV at 1, 2 and 4 h (p = 0.78) did not differ significantly between the study groups.
  
  
  
  Day-care LC using either diathermy hook or ultrasonic dissection resulted in excellent same-day discharge in both groups (87 %). LC with ultrasonic dissection does not offer any clinical advantages compared to diathermy dissection.
authors.affiliation: Department of Surgery, Central Hospital of Central Finland, Keskussairaalantie 19, 40620, Jyväskylä, Finland. anne.mattila@ksshp.fi.
authors.forename: Anne
authors.initials: A
authors.lastname: Mattila
authors.affiliation: Department of Surgery, Central Hospital of Central Finland, Keskussairaalantie 19, 40620, Jyväskylä, Finland.
authors.forename: Johanna
authors.initials: J
authors.lastname: Mrena
authors.affiliation: Unit of Primary Health Care, Helsinki University Hospital, 00029, Helsinki, Finland.
authors.forename: Hannu
authors.initials: H
authors.lastname: Kautiainen
authors.affiliation: Department of Anesthesiology and Intensive Care, Central Hospital of Central Finland, Jyväskylä, Finland.
authors.forename: Juha
authors.initials: J
authors.lastname: Nevantaus
authors.affiliation: Department of Surgery, Central Hospital of Central Finland, Keskussairaalantie 19, 40620, Jyväskylä, Finland.
authors.forename: Ilmo
authors.initials: I
authors.lastname: Kellokumpu
mesh_terms: D000556:Ambulatory Surgical Procedures; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D003972:Diathermy; D004210:Dissection / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D059708:Ultrasonic Surgical Procedures / Q000295:instrumentation
keywords: Cholecystectomy; Day surgery; Laparoscopy; Ultrasonic dissection