New trends in head and neck surgery: a prospective evaluation of the Harmonic Scalpel.
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The use of ultrasonic technology to cut and coagulate tissues with minimal tissue damage has been investigated in general surgery and gynecology. The purpose of this study was to verify the efficacy and applicability of the Harmonic Scalpel in head and neck surgery.A non-randomized study was undertaken on 40 pharyngolaryngectomies, 40 total laryngectomies, 40 radical neck dissections, and 40 superficial parotidectomies performed using the Harmonic Scalpel (80 patients) or "cold knife" dissection (80 patients). The evaluation included operation time, intraoperative blood loss, quantity of neck drainage on the first and second postoperative days, postoperative seroma formation, pattern of wound healing, days of hospitalization, and subjective assessment of postoperative pain.In patients treated with the Harmonic Scalpel, the mean operation time was significantly (p<0.05) shorter (119.1+/-1.35 vs. 156.9+/-1.51), intraoperative blood loss (121.5+/-1.28 vs. 257.5+/-2.32) and the quantity of neck drainage on the first (47+/-0.87 vs. 89+/-1.28) and second (38.7+/-0.86 vs. 75.5+/-1.34) postoperative days were significantly less, and the days of hospitalization (6.67+/-0.48 vs. 8.8+/-0.58) and the pain scores (3.24+/-0.63 vs. 5.91+/-0.83) were significantly lower than in the "cold knife" group. No postoperative complications were noted in the Harmonic Scalpel group.The use of the Harmonic Scalpel in head and neck surgery is safe and confers some advantages over conventional methods of head and neck dissection.Keywords:
Harmonic scalpel
Neck dissection
Seroma
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New, modern devices for tissue resection have been introduced in the surgical treatment of thyroid diseases recent years.Aim: To present our experience with the use of the harmonic scalpel in thyroid surgery.Patients and methods: For the period 2008 -2011, 1398 patients (6 to 74 years old) with various thyroid deseases were operated on in our clinic.The resection was performed through a classic Kocher , s collar incision in 583 patients, using minimally ivasive open access in 641 patients and with video-assisted technique in 174 patients.In all patients a harmonic scalpel device (Ethicon Endosurgery Care Inc) has been used.The length of surgical incision, use of haemostatic instruments and ligatures, extent of resection, need of draining, operative time, intra-and postoperative complications, length of postoperative hospital stay have been examined .Results: The volume of resection ranged from istmusectomy to total thyroidectomy.During all operation haemostatic instruments and ligatures have not been used.Lack of bleeding and shortend operating time -up to 45% were found.The use of draining is significantly reduced, regardless of the extent of resection.There was no increase in the incidence of intra-and postoperative complications.Òhe postoperative stay was significantly reduced. Conclusion:In our opinion, the introduction in use of the harmonic scalpel changes the face of modern thyroid surgery providing reliable hemostasis and shortening the operating time significantly.
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Objective: To investigate the ei cacy and safety of the use of harmonic scalpel in open thyroid surgery. Methods: Using a prospective randomized controlled trial design, 210 patients from February 2010 to May 2012 were divided into harmonic scalpel group and electric scalpel group with 105 cases in each group, and underwent open thyroidectomy with harmonic scalpel and conventional electric scalpel, respectively. All operations were completed by the same surgical team with a wide experience in thyroid surgery. The operative time, intraoperative blood loss and postoperative drainage volume for the same type of surgery, and postoperative complications between the two groups were compared.Results: There was no significant difference in age, sex, tumor size or type of disease between the two groups(all P0.05). The operative time, intraoperative blood loss and postoperative drainage volume for the same type of surgery in harmonic scalpel group were all reduced compared with electronic scalpel group, with all differences reached a statistical significance(all P0.05). No statistical difference was noted in postoperative complications between the two groups(P0.05). Conclusion: Harmonic scalpel combines hemostasis and sectioning in a single instrument, which simplii es the surgical procedure; use of harmonic scalpel in open thyroid surgery can shorten operative time and reduceintraoperative bleeding.
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Background Hemostasis in thyroid surgery is of utmost importance for a successful surgery and an uneventful postoperative course. Our aim was to evaluate the effectiveness of the FOCUS Harmonic Scalpel in patients undergoing open total thyroidectomy. Methods In this study, 778 patients were randomized into 2 groups based on the surgical technique used: group I comprised the conventional clamp-and-tie technique, group II comprised patients in whom the FOCUS Harmonic Scalpel was used exclusively. The groups were compared in regard to surgical time, complications, and hospital stay. Results Surgical time was significantly lower in group II compared with group I (79 ± 21.5 min vs.125 ± 30.4, respectively, P < 0.001). Twenty-seven patients (6.94%) in group I experienced symptomatic hypocalcemia requiring calcium and/or vitamin D therapy versus 14 patients (3.6%) in group II, with statistically significant difference (P < 0.05). Mean post-operative hospital stay was significantly lower in group II compared with group I (2.6 ± 0.9 vs. 2.9 ± 1.0; P < 0.001). Conclusions The FOCUS Harmonic Scalpel can shorten operative time and hospital stay, reduce incidence of symptomatic hypocalcemia but not transient hypoparathyroidism, and show no significance on recurrent nerve injury. FOCUS Harmonic Scalpel is supposed to be a more reliable and safe instrument that can take place of the clamp-and-tie technique in total thyroidectomy.
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Objective:To explore the value of a harmonic scalpel in totally extraperitoneal(TEP) inguinal hernioplasty.Methods:One hundred and thirty-seven patients who accepted TEP operation,were prospectively studied from March 2008 to August 2010 in our department:53 patients were accepted surgery with harmonic scalpel,84 patients were accepted standard surgery.The sex,age,follow-up time,type of hernia,surgery time,bleeding,intraoperative complications,transformation of other methods,postoperative drainage volume and complications were recorded.Results:There were no significant differences between harmonic scalpel group and control group at sex,age,follow-up time,type of hernia,surgery time,intraoperative complications,the second-day postoperative drainage volume and late postoperative complications(P0.05).The bleeding,the first-day postoperative drainage volume and hematoma,in harmonic scalpel group were significantly lower than those of control group(P0.01).Conclusions:The Harmonic Scalpel can be usd to reduce bleeding and complications.
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Objective:To evaluate the application value of sutureless technique using harmonic scalpel in open thyroid surgery.Methods:The clinical data of 148 patients undergoing thyroid surgery form October 2012 to June 2013 were retrospectively analyzed.Of the patients,sutureless technique using harmonic scalpel was applied during surgery in 78 cases(harmonic scalpel group),and high frequency electric knife combined with conventional hemostatic techniques such as suture ligation was performed in another 70 cases(conventional group).The operative time,intraoperative blood loss and the incidence of complications were compared between the two groups.Results:There was no statistical difference in surgical procedure and disease constitution between the two groups(P0.05).The operative time and intraoperative blood loss were significantly reduced in harmonic scalpel group compared with conventional group in the same surgical type(both P0.05).No postoperative bleeding,laryngeal recurrent nerve paralysis,or permanent hypoparathyroidism occurred in any of the patients of both groups,transient hypoparathyroidism occurred in one case in harmonic scalpel group and 2 cases in conventional group respectively and the overall incidence of postoperative complications in the two groups had no statistical difference(P0.05).Conclusion:Application of sutureless technique with harmonic scalpel in open thyroid surgery can shorten the operative time and reduce intraoperative blood loss,and does not increase the incidence of postoperative complications,so it has a certain value in clinical application.
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Introduction: The use of Harmonic Scalpel (HS) over Electrocautery (EC) in neck dissection has become standard of care in recent years. However, both the devices are presently widely used in practice and still serve large number of patients globally according to surgeon's choice and cost effectiveness.Objective: To evaluate the amount of peroperative blood loss in cancer patient undergoing selective neck dissection (Levels I, II and III) with Harmonic Scalpel (HS) and Electrocautery (EC).Methodology: The study was performed in the Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Biratnagar Hospital PVT LTD and Birat Medical College and Teaching Hospital, Nepal from June 2012 to February 2018. A total of 40 patients, 27 male and 13 female, aged 45 to 70 years diagnosed with oral cavity cancer were included in this prospective study. Two groups were formed, 20 patients in each group based on the surgical instrument used; Harmonic Scalpel (HS) and Electrocautery (EC). Data for age and sex of the patients were collected preoperatively. The surgery was performed under general anesthesia with endotracheal intubation and standard protocol was maintained during surgery. Amount of peroperative blood loss was measured and recorded. Data was processed and analyzed using SPSS and was compiled and test of significance was done using unpaired't' test.Results: The amount of peroperative blood loss was significantly lower in Harmonic Scalpel (HS) group then in Electrocautery (EC) group.Conclusion: Results from this study suggests that the Harmonic Scalpel (HS) is an effective device to reduce peroperative blood loss during selective neck dissection. BJHS 2018;3(2)6: 475-479
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Neck dissection
Electrocoagulation
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Partial glossectomy is the main treatment for tongue carcinoma. The resection of the tongue, which is a very vascularised tissue, requires a good hemostasis. The advantage of the harmonic scalpel is in combining sectioning and hemostasis in one single instrument, allowing a bloodless dissection of soft tissue. The aim of this prospective study was to evaluate the benefits and risks when using a harmonic scalpel in partial glossectomy. In this prospective study conducted in a university hospital from march 2004 to Decemeber 2008, eighteen consecutive patients underwent a partial glossectomy with the use of harmonic scalpel. Results were compared with previous surgical procedures performed between September 2000 and February 2004 by monopolar hemostasis by our team (n = 12) when the harmonic scalpel was not available. All 18 patients underwent partial glossectomy with the harmonic scalpel as the only instrument of section and hemostasis. The median blood loss was of 0 mL. The median operative time was 29 minutes (16 minutes less than partial glossectomies performed with conventional hemostasis. P < .001). No operative complications occurred. Two post-operative bleedings (5 days and 7 days after the glossectomy) occurred necessitating a new surgery to ligate the lingual artery. The margins of the resection were acceptable and no recurrence appeared. The harmonic scalpel makes it fast and easy to perform a partial glossectomy with no bleeding. Ligation of the lingual artery (when it is visualized during the dissection) should be performed because of the frequency (more than 10% in our series) and because of the potential gravity of a lingual post-operative bleeding.
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Harmonic scalpel
Neck dissection
Electrocoagulation
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Purpose. The aim of this prospective randomized trial was to compare operative factors, postoperative outcomes, and surgical complications of neck dissection (ND) when using the harmonic scalpel (HS) versus conventional haemostasis (CH) (classic technique of tying and knots, resorbable ligature, and bipolar diathermy). Materials and methods. Sixty-one patients who underwent ND with primary head and neck cancer (HNSCC) resection were enrolled in this study and were randomized into two homogeneous groups: CH (conventional haemostasis with classic technique of tying and knots, resorbable ligature, and bipolar diathermy) and HS (haemostasis with harmonic scalpel). Outcomes of the study included operative time, intraoperative blood loss, drainage volume, postoperative pain, hospital stay, and incidence of intraoperative and postoperative complications. Results. The use of the HS reduced significantly the operating time, the intraoperative blood loss, the postoperative pain, and the volume of drainage. No significant difference was observed in mean hospital stay and perioperative, and postoperative complications. Conclusion. The HS is a reliable and safe tool for reducing intraoperative blood loss, operative time, volume of drainage and postoperative pain in patients undergoing ND for HNSCC. Multicenter randomized studies need to be done to confirm the advantages of this technique and to evaluate the cost-benefit ratio.
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Diathermy
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Harmonic scalpel
Lymphadenectomy
Neck dissection
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