A comparison of the harmonic scalpel with clamp crushing technique for hepatic resection

Introduction: The ultrasonically activated shears (Harmonic Scalpel; Ethicon Endo-Surgery, Cincinnati, OH) has frequently been used for hepatic resection. However, no studies exist to address its safety and efficacy compared to the traditional clamp crushing technique of liver parenchymal transection. Methods: We retrospectively reviewed all hepatic resections between September 1992 to February 2002 at our institution. Patients were divided into two groups based on the technique of resection: clamp crushing versus harmonic scalpel. Standard clinico-patholog]c data were obtained. In addition, intra-operative courses were reviewed, examining blood loss, blood transfusion, and operative time. Follow-up care was reviewed for bile leaks, bleeding, and abscess formation. Standard statistical analysis was performed. Results: 243 non-cirrhotic patients underwent 248 hepatic resections. Sixtythree percent (N = 157) of liver resections were performed with the harmonic scalpel and 37% (N = 9t) were performed with the clamp crushing technique. The groups were similarly matched for age, gender, diagnosis, and co-morbidity (p = NS). Mean operative time (282 +/10.5 vs. 368+/-17.3 mini pharmonic scalpel group versus the clamp crushing group, respectively. Post-operative complications were similar between the two groups (20% (N= 31) v. 14% (N = 13); p=NS), but there was a trend towards a significant increase in bile leaks in the harmonic scalpel group (p = 0.07). A subset analysis of anatomic resections in the two groups revealed a statistically significant increase of bile leaks in the harmonic scalpel group (p=O.01). Conclusion: The harmonic scalpel can be used safely to perform liver surgery, with decreased operative time and blood loss. However, because of the increased incidence of postoperative bile leaks in anatomic resections, surgeons must be vigilant during liver parenchymal transection when using this device.