Intracorporeal ligation of the cystic duct and artery during laparoscopic cholecystectomy: do we need the endoclips?

Abstract

The introduction of laparoscopic cholecystectomy may have resulted in an increase of cystic duct leaks, which could be attributed to the use of endoclips. There are also reports of other complications associated with clips. Complications associated with clips can be avoided by using intracorporeal ligation. The time necessary to complete the ligation was measured from preparing the pedicle, to dividing the duct and artery in 170 cases. A 10 cm 2′0′ polyglactin tie was used to ligate the artery, proximally, and the cystic duct, both proximally and distally, and the structures were divided. We took 2-8 min (mean time = 4.03) from the end of preparation of the cystic pedicle to division of the structures using intracorporeal ligation. The cost of endoclips (ER 320-Ethicon) is approximately £152 per patient. The polyglactin ligature costs <£1. Ligation of the cystic duct and artery is safe and cost-effective. It does not add significantly to the operative time. Training should improve the skills necessary for secure intracorporeal knots, reducing the dependence on expensive disposable instruments.