Use of Harmonic Scalpel as an Alternative to Electrocautery in Patients with Cardiac Pacemakers in Laparoscopic Cholecystectomy

The use of electrocautery during surgery in patients with permanent cardiac pacemaker in situ can lead to pacemaker malfunction with potentially grave consequences. The use of unipolar electrocautery during surgery with permanent pacemaker may result in electromagnetic interference which can lead to complete asystole; pacemaker can either revert to the default program with pacing rate that is unable to maintain adequate cardiac output in particular patient; increase pacing threshold secondary to electromagnetic coupling with resultant endocardial thermal burns or irreversible loss of battery output. To overcome this problems with bipolar electrocautery preventive measures such as restricting electrocautery use to greater than 15 cm from the pulse generator, placing the grounding pad as far from the pacemaker as possible and reprogramming the pacemaker to an asynchronous or magnet mode before the electrocautery use. However all this measures are insufficient and can lead to adverse outcome sometimes. So here we tried a harmonic or ultrasonically activated scalpel which provides hemostasis without any electromechanical interference in patients with permanent cardiac pacemakers for laparoscopic cholecystectomy.