Abstract
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.
Highlights
Major otolaryngology procedures are often complicated by challenging anatomy, complex reconstructions, and long operative times
In the patients undergoing modified RND, the mean operative time was significantly shorter in the harmonic scalpel (HS) group (113.9 ± 17.3 minutes) compared with the conventional haemostasis (CH) group (149.5 ± 18.7 minutes; P < 0.001)
Significant results were found in the patients undergoing selective ND (SND)
Summary
Major otolaryngology procedures are often complicated by challenging anatomy, complex reconstructions, and long operative times. Many patients undergoing these treatments have comorbid medical conditions that complicate their care and may cause perioperative complications. Neck dissection (ND) has been recognized as an integral part of the surgical therapy of head and neck cancer since the 19th century [1, 2]. Many technical changes have been proposed; in particular, it has been modified to preserve vital vascular and nervous structures while maintaining its therapeutic efficacy. ND is commonly used in the treatment of cervical lymphatic metastases of malignant disease of the upper aerodigestive tract, thyroid, parotid, and skin of the head and neck. The rate of complications following ND accounts from 6% to 28%, it is generally a well-tolerated procedure. Placement of closed suction drains has been demonstrated to minimize postoperative complications [3,4,5,6]
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