None. Never. Because its crazy.

The closure of the cystic duct using ligasure is feasible and effective in laparoscopic cholecystectomy. However, it is important to keep a safe distance from other intra-abdominal structures when using thermal energy devices to prevent thermal collateral damage.

Why take the risk of thermal damage with the ligasure when clips or ties are cheaper and don't have this risk. I would kill a trainee who did this on my patients and wouldn't support any surgeon who did this and burnt or damaged the CBD.

I asked the question because I have seen two surgical groups in my country who perform this practice, obviously a publication in 2010 (doi: 10.1111/j.1477-2574.2010.00240.x) in experimental animals sowed more

doubt me, it does not seem safe, and the extension of the heat can damage the bile duct, wanted to know their opinions and experiences if it was the case

Ligasure and Enseal are very effective sealing devices,but still I apply at least one clip for the cystic duct.In one of ELSA conferences in Asia Pacific region A paper was presented few years ago sealing the cystic duct with Hormonic device on animal model with good success rate.This was debated well and the conclusion was atleast apply one clip.Lateral spread of the energy on to CBD is possible but does not occur as safe distance is usually maintained.

I agree - it's crazy, dangerous and stupid. Ligasure seals vessels not biliary structures. The device delivers an amount of sealing energy adapted to the vascular structures. If you review basic Hystology you will see that the differences between vessels and cystic duct are major and the amount of collagen is far higher in billiary structures. So the sealing effect will be weaker while the energy needed will be higher and also the application time, which brings higher lateral termal effect, and higher chances of CBD injury - immediate or late. Also, for the same hystologic reason the sealing will be suboptimal and probably some billiary leaks will appear.I used two times Ligasure in atypical hepatectomies and in both of them the haemorhage was absent but the biliaryleaks were present requiring targeted ligations.

If you go "far enough" from the CBD in order to avoid thermal injury you might leave a long enough cystic to act as a diverticulum, with proper pathology of course- so what's the point of the cholecistectomy?

And in order to reach stupidity boiling point- why use such an expensive device for colecistectomy? It's like using a fine japanese sword to cut trees in Amazon jungle just to prove it's sharp. Do we need a study for that?

I'm sorry if my comment will discomfort, but it seems that some "researchers" are against science.

Yes, I have used Enseal to divide the cystic duct but always at least with one clip across.Some difficult cases accidentally cystic duct was devided with energy device some developed leak requiring stenting.In very small number again accidentally, sealed cystic duct did not leak.I presume the reasons are either a long and narrow cystic duct or duct and and artery were clipped together.I strongly recommend my post graduates to double clip the cystic duct and check whether the whole circumference is in the clip or not otherwise use locking clips or an endoloop.This is the stranded policy in my unit where we perform about one thousand Lap chole's in an year.

I dread the need & use of any kind of energised dissection in laparoscopic cholecystectomy. Where is the need? Why to submit the patient to avoidable collateral energy trauma? Ligation & sealing with energy are totally different expressions, not mutually sustitutable.

Dr. Mogoanta presents a compelling arguement. As much I like using this energy source, I certainly would not endorse Ligaure alone for securing cystic stump.

why do you need to use expensive energy device for lap chole. IT IS ONLY LAP CHOLE. I have never used any kind of these devices for cholecystectomy at all. and will never use it for cystic duct, with or with out clips. keep it simple.

If you have enough financial resources to use energy sources it is safe for vascular structures and gallbladder dissection. Of course it must be very comfortable for surgeon performing lap chole with energy source. First of all surgery must be safety and  harmless for patient. At the end I will never use it for biliary strictures even though it is free.

Yes,but it was accidental as the the stone was impacted in the Hartman's pouch with a long cystic duct in patient's with diseased callots.ENSEAL(jnj) sealed it well but after realizing, cystic duct was dissected and clipped.One of of the papers in ELSA in Kualumpur few years ago was on sealing the cystic duct in Rat models with energy source.If i may remember most of them leaked.Explanation was the burnt tissue which has sealed will give way leading to leak.Otherwise in our large series we do routinely use as mentioned earlier discussion for dissection, for the artery and for Gallbladder.