Laser vs electrosurgery in laparoscopic cholecystectomy. A prospective randomized trial.

Overview

While much of the clamor over the optimal instrument for dissection of the gallbladder from the liver bed has died, there remain no prospective comparative data concerning this issue. We undertook a prospective randomized trial comparing the contact neodymium:YAG laser with monopolar electrosurgical dissection in 100 patients undergoing laparoscopic cholecystectomy. Electrosurgical dissection was performed with an "L" hook and spatula electrodes at 25 W coagulation current. Neodymium:YAG laser dissection was performed with a 1200-microns contact tip at 15 W continuous beam. Mean (+/- SD) gallbladder dissection time was 19.2 +/- 8.5 minutes with electrosurgery compared with 23.6 +/- 9.6 minutes with the laser. Estimated blood loss was significantly less in the electrosurgery-treated group. In six instances, laser malfunction or fiber fragmentation necessitated completing the dissection with electrosurgery. We conclude that electrosurgery appears to have significant advantages for dissection of the gallbladder during laparoscopic cholecystectomy.