{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T01:26:18Z","timestamp":1789694778485,"version":"4.0.1"},"reference-count":47,"publisher":"Springer Science and Business Media LLC","issue":"10","license":[{"start":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T00:00:00Z","timestamp":1756771200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T00:00:00Z","timestamp":1756771200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100002386","name":"Cairo University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100002386","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Surg Endosc"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>Laparoscopic cholecystectomy (LC) is the current gold standard for the management of acute cholecystitis, where ultrasonic dissection and electrocautery dissection are the two primary techniques used, however, it remains uncertain which approach is safer and more effective.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Objectives<\/jats:title>\n            <jats:p>This systematic review and meta-analysis aimed to compare the clinical outcomes of ultrasonic dissection versus electrocautery dissection in LC for acute cholecystitis, particularly in operative time, hospital stay, blood loss, intraoperative and postoperative complications.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Method<\/jats:title>\n            <jats:p>A systematic literature search was conducted in PubMed (MEDLINE), Scopus, Web of Science (WOS), EMBASE, and Cochrane CENTRAL up to January 7, 2025, following PRISMA guidelines. Eligible studies were randomized controlled trials (RCTs) comparing ultrasonic dissection and electrocautery dissection in LC for acute cholecystitis. Data extraction and risk-of-bias assessment were independently performed. Statistical analyses were conducted using Review Manager (RevMan 5.4), with heterogeneity assessed using I<jats:sup>2<\/jats:sup> statistics and a random-effects model where necessary.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>A total of 28 RCTs, comprising 3383 patients (1720 in the ultrasonic dissection group and 1663 in the electrocautery group), were included. The meta-analysis demonstrated that ultrasonic dissection significantly reduced operative time (\u2212\u20099.13\u00a0min, 95% CI \u2212\u20099.65 to \u2212\u20098.61, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001, I<jats:sup>2<\/jats:sup>\u2009=\u200997%), hospital stay (\u2212\u20090.95\u00a0days, 95% CI \u2212\u20091.74 to \u2212\u20090.17, <jats:italic>p<\/jats:italic>\u2009=\u20090.02, I<jats:sup>2<\/jats:sup>\u2009=\u2009100%), and blood loss (\u2212\u200927.60\u00a0ml, 95% CI \u2212\u200938.48 to \u2212\u200916.72, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.00001, I<jats:sup>2<\/jats:sup>\u2009=\u200998%). Subgroup analysis reduced heterogeneity in some outcomes. Risk-of-bias assessment showed variability in study quality, with concerns in allocation concealment and performance bias in certain RCTs.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Ultrasonic dissection demonstrated advantages over electrocautery dissection for laparoscopic cholecystectomy in patients with acute cholecystitis, including reduced operative time, lower blood loss, and shorter hospital stays. While some heterogeneity was observed among studies, ultrasonic dissection appears to be a safer and more efficient technique.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00464-025-12132-2","type":"journal-article","created":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T19:38:57Z","timestamp":1756841937000},"page":"6366-6382","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Safety and efficacy of ultrasonic dissection versus electrocautery dissection in laparoscopic cholecystectomy for acute cholecystitis: an updated systematic review and meta-analysis"],"prefix":"10.1007","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-1873-1422","authenticated-orcid":false,"given":"Ibrahim","family":"Moqbel","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmoud","family":"Albashier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario Maged","family":"Tawadros","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed Basyouni","family":"Helal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed Hussein","family":"Abdelbaset","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed Ihab","family":"Abdelmeguid","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Razan Sulieman","family":"Abdalqader","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed Youssef Abdou","family":"Youssef","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashraf Abdelmonem","family":"Elsayed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,9,2]]},"reference":[{"issue":"10","key":"12132_CR1","doi-asserted-by":"publisher","first-page":"965","DOI":"10.1001\/jama.2022.2350","volume":"327","author":"JR Gallaher","year":"2022","unstructured":"Gallaher JR, Charles A (2022) Acute cholecystitis: a review. JAMA 327(10):965\u2013975","journal-title":"JAMA"},{"issue":"5","key":"12132_CR2","doi-asserted-by":"publisher","first-page":"1011","DOI":"10.1007\/s10140-021-01944-z","volume":"28","author":"K Maddu","year":"2021","unstructured":"Maddu K, Phadke S, Hoff C (2021) Complications of cholecystitis: a comprehensive contemporary imaging review. Emerg Radiol 28(5):1011\u20131027","journal-title":"Emerg Radiol"},{"issue":"3","key":"12132_CR3","doi-asserted-by":"publisher","first-page":"169","DOI":"10.5005\/jp-journals-10030-1398","volume":"11","author":"BB Patin","year":"2022","unstructured":"Patin BB, Welsch JM, Davis CS (2022) Evidence-based guidelines for the management of acute cholecystitis. Panam J Trauma Crit Care Emerg Surg 11(3):169\u2013175. https:\/\/doi.org\/10.5005\/jp-journals-10030-1398","journal-title":"Panam J Trauma Crit Care Emerg Surg"},{"issue":"1","key":"12132_CR4","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1186\/s13017-024-00565-4","volume":"19","author":"M Blohm","year":"2024","unstructured":"Blohm M, Sandblom G, Enochsson L et al (2024) Ultrasonic dissection versus electrocautery dissection in laparoscopic cholecystectomy for acute cholecystitis: a randomized controlled trial (SONOCHOL-trial). World J Emerg Surg 19(1):34. https:\/\/doi.org\/10.1186\/s13017-024-00565-4","journal-title":"World J Emerg Surg"},{"issue":"2","key":"12132_CR5","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1007\/s00464-011-1872-1","volume":"26","author":"JEF Fitzgerald","year":"2012","unstructured":"Fitzgerald JEF, Malik M, Ahmed I (2012) A single-blind controlled study of electrocautery and ultrasonic scalpel smoke plumes in laparoscopic surgery. Surg Endosc 26(2):337\u2013342. https:\/\/doi.org\/10.1007\/s00464-011-1872-1","journal-title":"Surg Endosc"},{"key":"12132_CR6","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71","volume":"372","author":"MJ Page","year":"2021","unstructured":"Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD et al (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372:n71","journal-title":"BMJ"},{"key":"12132_CR7","unstructured":"Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors) (2024) Cochrane handbook for systematic reviews of interventions. Cochrane Training"},{"key":"12132_CR8","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4898","volume":"366","author":"JAC Sterne","year":"2019","unstructured":"Sterne JAC, Savovi\u0107 J, Page MJ, Elbers RG, Blencowe NS, Boutron I et al (2019) RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 366:l4898","journal-title":"BMJ"},{"issue":"1","key":"12132_CR9","doi-asserted-by":"publisher","first-page":"17","DOI":"10.5005\/jp-journals-10033-1295","volume":"10","author":"MH Abdelhady","year":"2017","unstructured":"Abdelhady MH, Salama AF (2017) Clipped vs clipless laparoscopic cholecystectomy using the ultrasonically activated (Harmonic) scalpel. World J Laparosc Surg 10(1):17\u201321","journal-title":"World J Laparosc Surg"},{"issue":"2","key":"12132_CR10","first-page":"314","volume":"44","author":"A Amjqa","year":"2019","unstructured":"Amjqa A (2019) Changing trends in laparoscopic cholecystectomy: clip less versus conventional technique. Rawal Med J 44(2):314\u2013318","journal-title":"Rawal Med J"},{"issue":"6","key":"12132_CR11","first-page":"916","volume":"5","author":"A Kmatm","year":"2023","unstructured":"Kmatm A (2023) A comparative study of monopolar electrocautery versus ultrasonic dissection of the gallbladder from the gallbladder bed in laparoscopic cholecystectomy. Int J Acad Med Pharm 5(6):916\u2013920","journal-title":"Int J Acad Med Pharm"},{"issue":"3","key":"12132_CR12","first-page":"999","volume":"9","author":"SH Baloch","year":"2015","unstructured":"Baloch SH, Afzal S, Hamid T (2015) Use of harmonic shear vs titanium clips in laparoscopic cholecystectomy: Experience in Nawaz Sharif Social Security Teaching Hospital Lahore. Pakistan J Med Health Sci 9(3):999\u20131001","journal-title":"Pakistan J Med Health Sci"},{"issue":"4","key":"12132_CR13","doi-asserted-by":"publisher","first-page":"593","DOI":"10.1089\/lap.2007.0227","volume":"18","author":"SS Bessa","year":"2008","unstructured":"Bessa SS, Al-Fayoumi TA, Katri KM, Awad AT (2008) Clipless laparoscopic cholecystectomy by ultrasonic dissection. J Laparoendosc Adv Surg Tech 18(4):593\u2013598","journal-title":"J Laparoendosc Adv Surg Tech"},{"issue":"8","key":"12132_CR14","first-page":"187","volume":"15","author":"S Bharti","year":"2023","unstructured":"Bharti S, Narayan R (2023) A prospective randomized controlled trial evaluating ultrasonic versus monopolar electrocautery dissection of gallbladder in laparoscopic cholecystectomy. Int J Curr Pharm Rev Res 15(8):187\u2013191","journal-title":"Int J Curr Pharm Rev Res"},{"key":"12132_CR15","doi-asserted-by":"publisher","DOI":"10.1186\/s13017-024-00565-4","author":"M Blohm","year":"2024","unstructured":"Blohm M, Sandblom G, Enochsson L, Cengiz Y, Bayadsi H, Hennings J et al (2024) Ultrasonic dissection versus electrocautery dissection in laparoscopic cholecystectomy for acute cholecystitis: a randomized controlled trial (SONOCHOL-trial). World J Emerg Surg. https:\/\/doi.org\/10.1186\/s13017-024-00565-4","journal-title":"World J Emerg Surg"},{"issue":"1","key":"12132_CR16","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1749-7922-9-53","volume":"9","author":"F Catena","year":"2014","unstructured":"Catena F, Di Saverio S, Ansaloni L, Coccolini F, Sartelli M, Vallicelli C et al (2014) The HAC trial (harmonic for acute cholecystitis): a randomized, double-blind, controlled trial comparing the use of harmonic scalpel to monopolar diathermy for laparoscopic cholecystectomy in cases of acute cholecystitis. World J Emerg Surg 9(1):1\u201310","journal-title":"World J Emerg Surg"},{"issue":"7","key":"12132_CR17","doi-asserted-by":"publisher","first-page":"810","DOI":"10.1002\/bjs.4982","volume":"92","author":"Y Cengiz","year":"2005","unstructured":"Cengiz Y, J\u00e4nes A, Grehn \u00c5, Israelsson LA (2005) Randomized clinical trial of traditional dissection with electrocautery versus ultrasonic fundus-first dissection in laparoscopic cholecystectomy. Br J Surg 92(7):810\u2013813","journal-title":"Br J Surg"},{"issue":"3","key":"12132_CR18","doi-asserted-by":"publisher","first-page":"624","DOI":"10.1007\/s00464-009-0649-2","volume":"24","author":"Y Cengiz","year":"2010","unstructured":"Cengiz Y, Dalenb\u00e4ck J, Edlund G, Israelsson LA, J\u00e4nes A, M\u00f6ller M et al (2010) Improved outcome after laparoscopic cholecystectomy with ultrasonic dissection: a randomized multicenter trial. Surg Endosc 24(3):624\u2013630","journal-title":"Surg Endosc"},{"issue":"1","key":"12132_CR19","doi-asserted-by":"publisher","first-page":"5871","DOI":"10.21608\/ejhm.2022.266662","volume":"89","author":"EA Ibrahim","year":"2022","unstructured":"Ibrahim EA, Alsayed MH (2022) Comparative study between traditional dissection with electrocautery versus ultrasonic dissection of the Gallbladder in laparoscopic cholecystectomy. Egypt J Hosp Med 89(1):5871\u20135874","journal-title":"Egypt J Hosp Med"},{"issue":"1","key":"12132_CR20","first-page":"126","volume":"30","author":"A Yehia","year":"2019","unstructured":"Yehia A, Mahmoud E, El-Desouky M (2019) Laparoscopic cholecystectomy using harmonic scalpel versus conventional laparoscopic cholecystectomy. Minia J Med Res 30(1):126\u2013131","journal-title":"Minia J Med Res"},{"issue":"3","key":"12132_CR21","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1089\/lap.2010.0455","volume":"21","author":"SK Jain","year":"2011","unstructured":"Jain SK, Tanwar R, Kaza RCM, Agarwal PN (2011) A prospective, randomized study of comparison of clipless cholecystectomy with conventional laparoscopic cholecystectomy. J Laparoendosc Adv Surg Tech 21(3):203\u2013208","journal-title":"J Laparoendosc Adv Surg Tech"},{"issue":"2","key":"12132_CR22","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1007\/s11605-009-1039-8","volume":"14","author":"T Kandil","year":"2010","unstructured":"Kandil T, Nakeeb AE, Hefnawy EE (2010) Comparative study between clipless laparoscopic cholecystectomy by harmonic scalpel versus conventional method: a prospective randomized study. J Gastrointest Surg 14(2):323\u2013328","journal-title":"J Gastrointest Surg"},{"key":"12132_CR23","doi-asserted-by":"publisher","DOI":"10.4293\/JSLS.2016.00037","author":"G Liao","year":"2016","unstructured":"Liao G, Wen S, Xie X, Wu Q (2016) Harmonic scalpel versus monopolar electrocauterization in cholecystectomy. JSLS J Soc Laparoendosc Surg. https:\/\/doi.org\/10.4293\/JSLS.2016.00037","journal-title":"JSLS J Soc Laparoendosc Surg"},{"issue":"5","key":"12132_CR24","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1503\/cjs.000411","volume":"55","author":"V Mahabaleshwar","year":"2012","unstructured":"Mahabaleshwar V, Kaman L, Iqbal J, Singh R (2012) Monopolar electrocautery versus ultrasonic dissection of the gallbladder from the gallbladder bed in laparoscopic cholecystectomy: a randomized controlled trial. Can J Surg 55(5):307\u2013311","journal-title":"Can J Surg"},{"issue":"10","key":"12132_CR25","first-page":"14","volume":"17","author":"MS Manoj","year":"2023","unstructured":"Manoj MS, Debata P, Debata I, Das SK (2023) Harmonic scalpel versus electrocautery and its outcome in laparoscopic cholecystectomy: a prospective interventional study. J Clin Diagn Res 17(10):14\u201317","journal-title":"J Clin Diagn Res"},{"issue":"9","key":"12132_CR26","doi-asserted-by":"publisher","first-page":"3867","DOI":"10.1007\/s00464-015-4691-y","volume":"30","author":"A Mattila","year":"2016","unstructured":"Mattila A, Mrena J, Kautiainen H, Nevantaus J, Kellokumpu I (2016) Day-care laparoscopic cholecystectomy with diathermy hook versus fundus-first ultrasonic dissection: a randomized study. Surg Endosc 30(9):3867\u20133872","journal-title":"Surg Endosc"},{"issue":"2","key":"12132_CR27","first-page":"157","volume":"27","author":"N Khan","year":"2013","unstructured":"Khan N, Ahmad M, Ahmad Z, Khan A, Sadiq M (2013) Safety of ultrasonic dissection versus conventional electrocautery dissection during laparoscopic cholecystectomy in terms of gall bladder perforation. J Postgrad Med Inst 27(2):157\u2013163","journal-title":"J Postgrad Med Inst"},{"issue":"10","key":"12132_CR28","doi-asserted-by":"publisher","first-page":"2536","DOI":"10.1007\/s00464-010-0999-9","volume":"24","author":"A El Nakeeb","year":"2010","unstructured":"El Nakeeb A, Askar W, El Lithy R, Farid M (2010) Clipless laparoscopic cholecystectomy using the harmonic scalpel for cirrhotic patients: a prospective randomized study. Surg Endosc 24(10):2536\u20132541","journal-title":"Surg Endosc"},{"issue":"1","key":"12132_CR29","first-page":"262","volume":"12","author":"D Patel","year":"2023","unstructured":"Patel D (2023) Comparison of monopolar electrocautery and ultrasonic dissection of gallbladder in laparoscopic cholecystectomy. Int J Life Sci Biotechnol Pharma Res 12(1):262\u2013265","journal-title":"Int J Life Sci Biotechnol Pharma Res"},{"issue":"7","key":"12132_CR30","doi-asserted-by":"publisher","first-page":"597","DOI":"10.1089\/lap.2009.0375","volume":"20","author":"AA Redwan","year":"2010","unstructured":"Redwan AA (2010) Single-working-instrument, double-trocar, clipless cholecystectomy using harmonic scalpel: a feasible, safe, and less invasive technique. J Laparoendosc Adv Surg Tech 20(7):597\u2013603","journal-title":"J Laparoendosc Adv Surg Tech"},{"issue":"4","key":"12132_CR31","first-page":"1390","volume":"10","author":"A Shabbir","year":"2016","unstructured":"Shabbir A, Hussain S (2016) Comparison of gallbladder perforation during dissection from liver bed in patients undergoing monopolar electrocautery with those undergoing ultrasonic dissection during lap. cholecystectomy. Pak J Med Health Sci 10(4):1390\u20131392","journal-title":"Pak J Med Health Sci"},{"issue":"3","key":"12132_CR32","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1089\/lap.2013.0048","volume":"24","author":"F Sista","year":"2014","unstructured":"Sista F, Schietroma M, Abruzzese V, Bianchi Z, Carlei F, De Santis G et al (2014) Ultrasonic versus standard electric dissection in laparoscopic cholecystectomy in patients with acute calculous cholecystitis, complicated by peritonitis: Influence on the postoperative systemic inflammation and immune response, a prospective randomized. J Laparoendosc Adv Surg Tech 24(3):151\u2013158","journal-title":"J Laparoendosc Adv Surg Tech"},{"issue":"8","key":"12132_CR33","doi-asserted-by":"publisher","first-page":"2856","DOI":"10.1007\/s00464-013-2841-7","volume":"27","author":"F Temp\u00e9","year":"2013","unstructured":"Temp\u00e9 F, J\u00e4nes A, Cengiz Y (2013) Cost analysis comparing ultrasonic fundus-first and conventional laparoscopic cholecystectomy using electrocautery. Surg Endosc 27(8):2856\u20132859","journal-title":"Surg Endosc"},{"issue":"9","key":"12132_CR34","doi-asserted-by":"publisher","first-page":"68","DOI":"10.36478\/makrjms.2024.9.68.72","volume":"18","author":"T Zameer Ulla","year":"2024","unstructured":"Zameer Ulla T, Yashwanth CN, Chaunal WG (2024) Study to compare monopolar electrocautery versus ultrasonic dissection of gallbladder in laparoscopic cholecystectomy. Res J Med Sci 18(9):68\u201372","journal-title":"Res J Med Sci"},{"issue":"3\u20134","key":"12132_CR35","first-page":"16","volume":"25","author":"SAA Ramzanali","year":"2013","unstructured":"Ramzanali SAA, Zia-ul-Islam A, Shah SSH (2013) Monopolar electrocautery versus ultrasonic dissection of the gallbladder from the gallbladder bed in laparoscopic cholecystectomy. J Ayub Med Coll Abbottabad 25(3\u20134):16\u201318","journal-title":"J Ayub Med Coll Abbottabad"},{"issue":"7","key":"12132_CR36","doi-asserted-by":"publisher","first-page":"2054","DOI":"10.18203\/2349-2902.isj20212706","volume":"8","author":"H Mathur","year":"2021","unstructured":"Mathur H, Sharma AK, Kalwaniya DS (2021) Comparative study to evaluate ultrasonic versus monopolar electrocautery dissection of gallbladder in laparoscopic cholecystectomy. Int Surg J 8(7):2054","journal-title":"Int Surg J"},{"key":"12132_CR37","unstructured":"Nicholas M, Vu T, Patel D (2007) A clipless technique for laparoscopic cholecystectomy using the Harmonic scalpel. ASGBI oral presentation, Manchester, UK, April 19th, 2007\u2014benign hepatobiliary section"},{"key":"12132_CR38","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1007\/s00423-004-0471-1","volume":"389","author":"R Bittner","year":"2004","unstructured":"Bittner R (2004) The standard of laparoscopic cholecystectomy. Langenbecks Arch Surg 389:157\u2013163","journal-title":"Langenbecks Arch Surg"},{"key":"12132_CR39","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1089\/lps.1991.1.325","volume":"1","author":"JF Smith","year":"1991","unstructured":"Smith JF, Boysen D, Tschirhart J, Williams T (1991) Risks and benefits of laparoscopic cholecystectomy in the community hospital setting. J Laparoendosc Surg 1:325\u2013332","journal-title":"J Laparoendosc Surg"},{"key":"12132_CR40","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1590\/s0102-67202015000100014","volume":"28","author":"AC Ramo","year":"2015","unstructured":"Ramo AC, Ramos MG, Galv\u00e3o-Neto MP et al (2015) Total clipless cholecystectomy by means of harmonic sealing. Arq Bras Cir Dig 28:53\u201356","journal-title":"Arq Bras Cir Dig"},{"key":"12132_CR41","doi-asserted-by":"publisher","first-page":"23","DOI":"10.4293\/108680810X12674612014383","volume":"14","author":"W Sasi","year":"2010","unstructured":"Sasi W (2010) Dissection by ultrasonic energy versus monopolar electrosurgical energy in laparoscopic cholecystectomy. JSLS 14:23\u201334","journal-title":"JSLS"},{"key":"12132_CR42","doi-asserted-by":"publisher","first-page":"817","DOI":"10.1007\/s00268-010-0819-3","volume":"35","author":"B Kavlakoglu","year":"2011","unstructured":"Kavlakoglu B, Pekcici R, Oral S (2011) Clipless cholecystectomy: which sealer should be used? World J Surg 35:817\u2013823","journal-title":"World J Surg"},{"key":"12132_CR43","doi-asserted-by":"publisher","first-page":"1","DOI":"10.4293\/JSLS.2016.00037","volume":"20","author":"G Liao","year":"2016","unstructured":"Liao G, Wen S, Xie X et al (2016) Harmonic scalpel versus monopolar electrocauterization in cholecystectomy. JSLS 20:1\u20137","journal-title":"JSLS"},{"key":"12132_CR44","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1001\/archsurg.2009.236","volume":"145","author":"DJ Humes","year":"2010","unstructured":"Humes DJ, Ahmed I, Lobo DN (2010) The pedicle effect and direct coupling: delayed thermal injuries to the bile duct after laparoscopic cholecystectomy. Arch Surg 145:96\u201398","journal-title":"Arch Surg"},{"key":"12132_CR45","doi-asserted-by":"publisher","first-page":"3059","DOI":"10.1007\/s00464-014-3579-6","volume":"28","author":"BB Agarwal","year":"2014","unstructured":"Agarwal BB, Agarwal N, Agarwal KA et al (2014) Outcomes of laparoscopic cholecystectomy done with surgical energy versus done without surgical energy: a prospective randomized control study. Surg Endosc 28:3059\u20133067","journal-title":"Surg Endosc"},{"issue":"139","key":"12132_CR46","first-page":"145","volume":"45","author":"R DerSimonian","year":"2015","unstructured":"DerSimonian R, Laird N (2015) Meta-analysis in clinical trials revisited. Contemp Clin Trials 45(139):145","journal-title":"Contemp Clin Trials"},{"key":"12132_CR47","unstructured":"McMaster University (developed by Evidence Prime, Inc.) (2020) GRADEpro GDT: GRADEpro Guideline Development Tool [Software]. https:\/\/gradepro.org\/cite\/grade pro.org"}],"container-title":["Surgical Endoscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00464-025-12132-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00464-025-12132-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00464-025-12132-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,6]],"date-time":"2025-10-06T20:04:17Z","timestamp":1759781057000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00464-025-12132-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,2]]},"references-count":47,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2025,10]]}},"alternative-id":["12132"],"URL":"https:\/\/doi.org\/10.1007\/s00464-025-12132-2","relation":{},"ISSN":["0930-2794","1432-2218"],"issn-type":[{"value":"0930-2794","type":"print"},{"value":"1432-2218","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,2]]},"assertion":[{"value":"11 April 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 August 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 September 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare that there are no conflicts of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}