Laser or electrocautery for laparoscopic cholecystectomy?

Overview

There are few concerns related to laparoscopic cholecystectomy that evoke as much emotion as the question of which is the superior energy source, laser or electrocautery. Monopolar radio frequency electricity (electrosurgery) and collimated coherent light (laser) injure tissue by the generation of heat, and in this regard are remarkably similar. The greatest differences between these sources of heat are related to predictability of injury, selective absorption of free beam laser energy, ability to coagulate, and cost. Although there are no prospective data yet available to answer the question of superiority, it appears that electrosurgical dissection may be faster and is generally less costly. Laser dissection may be more precise. In difficult cases, hemostasis appears to be superior with electrosurgery.