Abstract
BackgroundWe performed an umbrella review of systematic reviews summarizing the evidence on the Harmonic scalpel (HS) compared with conventional techniques in surgical oncology (including lymph node dissection).MethodsWe searched MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews from inception to end of March of 2017 for meta-analyses or systematic reviews of randomized trials comparing HS to conventional techniques in surgical oncology. We assessed the quality of included systematic reviews with AMSTAR (A MeaSurement Tool to Assess systematic Reviews) and assessed the certainty in evidence for each pooled outcome using GRADE (Grading of Recommendations Assessment, Development, and Evaluation).ResultsWe identified ten systematic reviews on breast cancer (n = 3), gastric cancers (n = 3), oral, head, and neck cancers (n = 1), and colon cancers (n = 3). Most reviews received a higher rating using AMSTAR. For operative time, systematic reviews reported a reduction of 25 to 29 min for HS compared with conventional methods across oncology types, with the exception of breast cancer where little differences were observed (very low to moderate quality of evidence (GRADE)). For blood loss and drainage volume, the majority of reviews reported statistically significant reductions with HS, and reductions ranged from 42 to 141 mL, and from 42 to 292 mL, respectively (very low to moderate quality of evidence). Hospitalization days were reported to decrease with use of HS by 0.2 to 3.2 days; however, reductions were only statistically significant for half of the included reviews (low to moderate quality of evidence). Regarding perioperative complications, two of six reviews reported a significantly reduced risk with HS use (breast cancer surgery) (moderate to high quality evidence)).ConclusionAcross surgical oncology types, the majority of included systematic reviews showed a statistically significant or numerical improvement in surgical outcomes with use of the HS compared with conventional methods. Well-designed randomized studies with large sample sizes will help to provide more precise estimates and reduce the risk of heterogeneity.
Highlights
We performed an umbrella review of systematic reviews summarizing the evidence on the Harmonic scalpel (HS) compared with conventional techniques in surgical oncology
The risk of bias was assessed in five Systematic review (SR) using the Cochrane risk of bias assessment tool, two SRs did not assess the risk of bias of their included Randomized control trial (RCT), and the remaining SRs used the Jadad scale to assess the quality of included RCTs
After accounting for overlapping trials and considering only those focusing on HS versus conventional methods, we identified 32 unique RCTs: 10 in gastric cancer; 12 in breast cancer; 7 in oral, head, and neck cancer; and 3 in colon cancer
Summary
We performed an umbrella review of systematic reviews summarizing the evidence on the Harmonic scalpel (HS) compared with conventional techniques in surgical oncology (including lymph node dissection). Various new surgical devices and technologies have been introduced in the past three decades to improve the efficiency of surgical procedures—either to achieve a range of desired tissue dissection, transection, and hemostasis or to reduce operative time and postoperative complications [1–4]. One such technological advancement included the introduction of ultrasonic cutting and coagulation of soft tissues [5, 6]. The Harmonic scalpel (HS) is a device that uses ultrasonic energy for cutting of the tissues, tissue dissection, and coagulation [6]. Many systematic reviews (SRs) and meta-analyses have demonstrated the significant clinical benefits of using HS in various types of surgeries, including a reduction in operative time, intra-operative blood loss, post-operative drainage volume, post-operation complications, and duration of hospital stay [11–17]
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