Abstract
BackgroundParotidectomy is one of the most commonly performed procedures by otorhinolaryngologists. Traditionally dissection is performed with a combination of a steel scalpel and bipolar cautery; however, starting in the early 2000s, the Harmonic scalpel has provided an alternative method for dissection and hemostasis. The purpose of this study is to compare operative time, blood loss, complications, and cost between the Harmonic scalpel and steel scalpel plus bipolar cautery for superficial and total parotidectomy.MethodsRetrospective cohort of patients who underwent superficial or total parotidectomy with the Harmonic or cold steel between 2000 and 2015. Across 255 patients, comparison between operative time, blood loss, complications, and cost was performed.ResultsSuperficial parotidectomy was performed on 120 patients with the Harmonic and 54 with steel scalpel. Total parotidectomy was performed on 59 patients using the Harmonic and 22 patients with cold steel. For superficial parotidectomy, the Harmonic reduced operative time (216 ± 42 vs. 234 ± 54 min, p = 0.03) and decreased blood loss (28 ± 19 vs. 76 ± 52 mls, p < 0.05). With total parotidectomy the Harmonic decreased operative time (240 ± 42 vs. 288 ± 78 min, p = 0.01) and reduced blood loss (38 ± 21 mls vs. 85 ± 55 mls, p < 0.05). There were no differences in complication rates between groups. Harmonic use was associated with surgical cost reduction secondary to reduced operative times.ConclusionsThe Harmonic scalpel decreases blood loss and operating time for superficial and total parotidectomy. Shorter operative times may decrease the overall cost of parotidectomy.
Highlights
Parotidectomy is one of the most commonly performed procedures by otorhinolaryngologists
Superficial parotidectomy A total of 174 patients underwent superficial parotidectomy, 120 with the Harmonic scalpel (HS) and 54 with scalpels plus bipolar cautery (SB)
Use of the HS compared with SB resulted in shorter duration of surgery (216 ± 42 vs. 234 ± 54 min, p = 0.03) and less blood loss (28 ± 19 mls vs. 76 ± 52 mls, p < 0.05), but no significant difference in post-operative drain output (24 ± 15 mls vs. 43 ± 36 mls, p = 0.09) or complications (Table 3)
Summary
Parotidectomy is one of the most commonly performed procedures by otorhinolaryngologists. Dissection is performed with a combination of a steel scalpel and bipolar cautery; starting in the early 2000s, the Harmonic scalpel has provided an alternative method for dissection and hemostasis. The purpose of this study is to compare operative time, blood loss, complications, and cost between the Harmonic scalpel and steel scalpel plus bipolar cautery for superficial and total parotidectomy. The procedure is technically challenging and time-consuming as it requires careful dissection of the facial nerve in a region with high vascularity. The HS has been shown to reduce operative time and intra-operative blood loss across a range of otolaryngologic procedures including thyroidectomy, parotidectomy, glossectomy, and neck dissection [4,5,6,7]
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