Background: The primary use of the Harmonic scalpel in laparoscopic cholecystectomy has been for the division of the cystic artery and liver bed dissection. In this study, we evaluate the safety & efficacy of Harmonic scalpel as the sole instrument for division of the cystic duct and artery as well as dissection of the liver bed (clipless cholecystectomy).
Methods:  A prospective, non randomized clinical trial was conducted on 21 consecutive patients with symptomatic gall bladder stones who underwent laparoscopic cholecystectomy (LC) in the surgical department, Ain Shams University Hospital, over a period of six months. In all patients, Harmonic scalpel was the sole instrument used to seal and divide the cystic artery and duct as well as for dissection of the gall bladder bed. The operative time, operative blood losses, intraoperative and postoperative complications especially bile leaks, hospital stay as well as cost were evaluated. A short term postoperative follow up was done for all patients for one month.
Results: Twenty (95.2%) successful clipless laparoscopic cholecystectomies were conducted with no open conversion. One patient (4.8%) early in the series developed postoperative bile leakage, which was managed by ERCP. There were no other complications in our series. The operative time ranged from 60-100 minutes (median= 80min.). The hospital stay was 1-3 days (median= 2 days). No gall bladder perforations occurred and the quality of the operative field was excellent with traces or minimal blood loss.
Conclusion:  Clipless laparoscopic cholecystectomy by Harmonic scalpel (shears) is safe and   effective   to   carry   out   after   completing   the   required   learning   curve.