Cauterizing Arteries in Laparoscopic Cholecystectomy May Be Dangerous

A new study shows that eliminating unnecessary and dangerous cauterization in laparoscopic cholecystectomy surgery could reduce concerns of arcing, infection spread, and damage to surrounding structures.

Researchers at Sir Ganga Ram Hospital (New Delhi, India) examined a study group that consisted of 74 patients randomly selected among the hospitals laparoscopic cholecystectomy candidates who were not cauterized during surgery; a second group of 79 patients was randomly assigned to a control group and did have energy used for cauterization during their procedures. Both the study and control groups had similar demographic and disease profiles. All candidates were operated on by fully qualified laparoscopic surgeons, and there were no elimination criteria.

The results showed that the researchers encountered no additional technical difficulty with the study group and found that they required no additional instruments to complete the surgery. All patients in the study group went home between 4 and 6 hours after surgery. None of the patients in the study group had any complications compared with patients in the control group. Seven of the patients who were subjected to energy devices required rehospitalization, compared to none in the study group. Of the patients in the control group, 11 had biliary leaks, compared to two patients in the study group. Finally, two patients in the control group died from sepsis, whereas all members of the study group survived. The researchers stated that the damage caused by cauterization is slow in developing and can manifest 3 or 4 days after surgery. The study was presented at the Society of American Gastrointestinal and Endoscopic Surgeons 2008 annual scientific session and postgraduate course, held during April 2008 in Philadelphia (PA, USA).

"If we are cutting in the right area in the right plane, God has given us areas where there is no bleeding,” said lead author Brij Agarwal, M.D., MBBS, M.Sc. "This is taught to basic medical students.”

Dr. Agarwal explained that especially around diseased organs, there are often easily identifiable areas where there is an absence of veins. All one has to do is clamp the artery supplying that area, and there will be no bleeding as the tissue is cut. It then follows that if there is no bleeding, there is no need for cauterization, and no need for energy devices to heat and possibly damage the surrounding areas such as the intestine or the bile duct.


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