Harmonic Scalpel over Electrocautery, Evaluation of Peroperative Blood Loss in Selective Neck Dissection: A Comparative Study

Atul Kumar Agrawal,Manish Agrawal,Nancy Bansal Agrawal,Quazi Billur Rahman,Sanjeev Kumar Thakur

doi:10.3126/bjhs.v3i2.20964

Abstract

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

Highlights

In Head and Neck region, squamous cell carcinoma (SCC) is the most common form of malignancy
It is worth inves ga ng the procedure to reduce the bleeding, this study shows that the surgery performed by Harmonic Scalpel (HS) significantly reduces blood loss in pa ents undergoing selec ve neck dissec on for oral cavity cancer
HS has an advantage over EC, it increases visibility, decrease blood loss peropera vely, reduces opera ve me and helps avoid placement of drain in neck dissec on.[13, 14]

Summary

Introduction

In Head and Neck region, squamous cell carcinoma (SCC) is the most common form of malignancy. Management of primary lesion, regional nodes and distant metastasis is the three major components of the treatment of the oral cancer. Wide three dimensional (3D) surgical excision of primary lesion followed by neck dissec on is s ll main protocol of treatment for all operable cases. Harmonic Scalpel (HS) added a new dimension in addi on to Electrocautery (EC) with minimal blood loss specially in case of tongue and neck. Cancer is the end product of an unregulated prolifera on of cells resul ng from muta ons in precursor cell.[1] Oral cancer is the 8th most frequent cancer in the world among males and 14th among females.[2] The incidence of oral cancer in male is 8.0% and female is 4.3% in India and 12.3% and 8.7% respec vely for male and female in Pakistan.[3]

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Discussion

Conclusion