ULTRASONIC VS ELECTROCAUTERY DISSECTION IN LAPAROSCOPIC CHOLECYSTECTOMY: A COMPREHENSIVE META-ANALYSIS OF 2,982 PATIENTS FROM RANDOMIZED TRIALS montano.enrique@uabc.edu.mx

 

ULTRASONIC VS ELECTROCAUTERY DISSECTION IN LAPAROSCOPIC CHOLECYSTECTOMY: A COMPREHENSIVE META-ANALYSIS OF 2,982 PATIENTS FROM RANDOMIZED TRIALS

7

 

 

 

 

Mexico

Oral only

Laparoscopic cholecystectomy is the gold standard for gallstone-related conditions, traditionally performed with monopolar electrocautery. However, ultrasonic dissection has gained attention for enhancing surgical precision, reducing thermal damage, and minimizing complications. This meta-analysis aimed to compare the efficacy and safety of ultrasonic dissection and monopolar electrocautery in laparoscopic cholecystectomy, exclusively evaluating RCTs.

PubMed, EMBASE, and Cochrane databases were searched for RCTs comparing ultrasonic dissection with monopolar electrocautery. Studies were searched until February, 2025. The primary outcome was gallbladder perforation. Secondary outcomes included operative time, intraoperative blood loss, and bile leaks. Data were analyzed using risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs), employing a random-effects model.

A total of 24 randomized controlled trials encompassing 2,982 patients were included. Compared to electrocautery, ultrasonic dissection was associated with significantly lower gallbladder perforation rates (RR 0.37; 95% CI, 0.30 to 0.46, P < 0.00001, I² = 0%), shorter operative time (MD -10.32 minutes; 95% CI, -14.65 to -6.00, P < 0.00001, I² = 96%), reduced intraoperative blood loss (MD -24.96 mL; 95% CI, -36.05 to -13.86, P < 0.0001, I² = 98%), and fewer bile leaks (RR 0.47; 95% CI, 0.27 to 0.82, P = 0.008, I² = 0%).

Given the low heterogeneity among RCTs, ultrasonic dissection correlates with improved outcomes compared to monopolar electrocautery in laparoscopic cholecystectomy, demonstrating advantages in surgical precision and reduced complications. Further research should assess its cost-effectiveness and feasibility in varied surgical settings to optimize patient care and inform clinical practice.