Comparing the Ultrasonically Activated Scalpel (Harmonic) with High-Frequency Electrocautery for Postoperative Serous Drainage in Massive Weight Loss Surgery

Abstract

Sir: Ultrasonic dissection using the Harmonic scalpel has recently emerged as a safe and reliable alternative to high-frequency electrocautery. The Harmonic ultracision scalpel and scissor has been used successfully by surgeons in laparoscopic and open surgical procedures, including cholecystectomy and breast cancer dissections.1–4 The aim of this prospective, single-blinded, two-arm study was to investigate the clinical merits of the ultrasonic scalpel (Harmonic) versus high-frequency electrocautery in body lift operations with regard to postoperative serous drainage time and volume. Lower body lift procedures without simultaneous tightening of the medial aspect of the thigh were carried out in 20 patients with two treatment arms. Tissue dissection and resection were performed using the ultrasonic scalpel (Harmonic) on one side (treatment arm 1, n = 20) and electrocautery on the other (treatment arm 2, n = 20). All operations were performed by the senior author (D.F.R.). Drainage days (i.e., number of days until drain removal) and total drainage (i.e., postoperative wound secretion via the individual drains) were assessed as primary endpoints. In addition, operative time (from first skin incision until last skin suture), postoperative complications, and the difference in preoperative and postoperative thigh circumference were recorded; the pain score (per day) was measured using a 10-point visual analog scale, with 0 = no pain and 10 = the worst imaginable pain (secondary endpoints). Student t tests for independent samples were used for inferential statistical analysis. Total serous drainage volume was significantly lower in the Harmonic scalpel group (891.67 ± 392.09 ml) compared with the electrocautery group (1414.38 ± 656.90 ml) (p = 0.007). Similarly, the number of drainage days was significantly lower in the Harmonic scalpel group (5.35 ± 1.14 days, compared with 7.04 ± 1.92 days for electrocautery; p = 0.002). Patients in the Harmonic scalpel group reported lower pain intensity scores (mean score ± SD for postoperative days 1 through 15, 1.84 ± 0.58, compared with 2.44 ± 0.71 for electrocautery; p = 0.011). The incidence of complication was assessed for each side of the body. On the electrocautery side, seroma formation was observed in five patients (25 percent) and treated by aspiration [Harmonic side, two patients (10 percent)]. Two of these five patients presented with bilateral seroma formation in the area of the lateral thigh, and the other three patients showed a unilateral mass formation that required treatment by aspiration. No patient had postoperative bleeding, but one patient (5 percent) required a postoperative blood transfusion due to extensive intraoperative blood loss that included both the electrocautery and Harmonic sides. Three patients (15 percent) had delayed wound healing due to local wound infections that involved both sides. No wound necrosis requiring treatment was assessed in this study. The Harmonic scalpel allows for safe and efficient tissue dissection in massive weight loss procedures. In addition, the results show that use of the Harmonic scalpel in tissue dissection significantly reduces the postoperative serous drainage time and volume as well as postoperative pain in comparison with electrocautery, with increased patient comfort postoperatively. DISCLOSURES Drs. Reichenberger and Stoff have no financial interest in any of the products, devices, or drugs mentioned in this article. Dr. Richter has a consulting agreement with Ethicon. Alexander Stoff, M.D. Matthias A. Reichenberger, M.D. Dirk F. Richter, M.D. Department of Plastic and Reconstructive Surgery Dreifaltigkeits Hospital Wesseling, Germany