OBJECTIVES: Harmonic® ultrasonic energy devices have been developed as a safer and more efficient alternative to traditional electrosurgery (monopolar and bipolar) in laparoscopic cholecystectomy. However, the economic impact on hospital cost has not yet been assessed in the United States. The aim of the study is to evaluate the total cost of laparoscopic cholecystectomy performed with an ultrasonic device versus electrosurgery from a hospital perspective. METHODS: A literature review was performed to identify publications via EMBASE and MEDLINE database.  Nine randomized controlled studies were included in this analysis based on inclusion criteria.  The clinical results were weighted based on No. of patients to calculate averages for both energy devices.  The total departmental cost data for electrosurgery group were obtained from a large US payor (PREMIER database) to apply the clinical findings to calculate the cost for the Harmonic group. The total cost in laparoscopic cholecystectomy with two energy devices was compared to determine which modality is more cost effective. RESULTS: The total case cost using an ultrasonic device in an inpatient laparoscopic cholecystectomy is $7701 v.s. electrosurgery is $8637.  The use of an ultrasonic device provides a hospital savings of $936 per patient treated. The savings mainly resulted from shorter operating time (13 Minutes) and decreased hospital stay (0.7 days). CONCLUSIONS: Although the instrument cost is higher for the ultrasonic device, the total procedural cost is lower compared to electrosurgery. Utilization of the Harmonic® ultrasonic device in laparoscopic cholecystectomy can lead to substantial cost savings for US hospitals.