Harmonic Scalpel Dissection Research Articles

Outcomes of Harmonic Scalpel and Electrocautery in Patients Who Underwent Modified Radical Mastectomy.

ObjectiveThis study aimed to compare the mean operative time, total analgesic required, and the mean number of drainage days in harmonic scalpel versus electrocautery in breast cancer patients undergoing modified radical mastectomy (MRM).MethodologyThis retrospective cross-sectional study was conducted in the Department of General Surgery, Jinnah Postgraduate Medical Center (JPMC). The duration of the study was six months, from January 2018 until July 2018. A total of 194 females with biopsy-proven breast cancer undergoing MRM were included in the study. They were divided into two groups. In group ‘A', a harmonic scalpel was used, and in group 'B', electrocautery was used for hemostasis.ResultsThe mean age of the participants was 48.68 ±10.04 years. The mean operative time was 102.13 ±2.04 minutes. The mean number of days of drainage was 1.27 ±2.63. The mean analgesia amount was 30.72 ±3.25 mg. In the harmonic scalpel group, the mean operative time was 100.43 ±0.89 minutes, whereas, in the electrocautery group, it was 103.86 ±1.12 minutes with a significant difference (p=0.001). In the harmonic scalpel group, the mean number of drainage days was 8.90 ±0.42, whereas, in the electrocautery group, it was 13.58 ±1.26 with a statistically significant difference (p=0.001). In the harmonic scalpel group, the mean analgesia amount was 1,800.5 ±353.55 mg, whereas, in the electrocautery group, it was noted to be 2,006.25 ±289.43 with a statistically significant difference (p=0.001).ConclusionThis study concludes that compared with standard electrocautery, harmonic scalpel dissection is associated with significant benefits in decreasing postoperative drainage and blood loss during operations after MRM for breast cancer.

A NOVEL TECHNIQUE OF HARMONIC TISSUE DISSECTION REDUCES POSTOPERATIVE HEMATOMA, FLAP NECROSIS, WOUND SEPSIS AFTER MODIFIED RADICAL MASTECTOMY COMPARED TO CONVENTIONAL ELECTROCAUTERY

Background: Breast cancer is a serious public health problem with high incidence and prevalence coefficients. This study was undertaken with the intention to evaluate the benefits of harmonic scalpel dissection over electrocautery in MRM.
 Methods: This comparative study was conducted in Department of Surgery, IGMC Shimla over a period of one year from 1 July 2015 to 30 June 2016. Histologically proven cases of carcinoma breast presenting in the surgery OPD or admitted in the surgery wards were included in the present study.
 Results: Postoperative hematoma occured in 1 patient of Electrocautery Group, which was drained. There were no cases of postoperative hematoma in Harmonic Group. This difference was not found to be statistically significant with P value=.313. Postoperative flap necrosis occurs in 1 (3%) patient of harmonic MRM Group and 4(11.8%) patients of electrocautery MRM Group. This difference was not found to be statistically significant with P value 0 .1633. Postoperative wound sepsis occurs in 2 (5%) patient of Harmonic MRM Group and 5(14%) patients of Electrocautery MRM Group. This difference was not found to be statistically significant with P value 0.2312.
 Conclusion- Harmonic scalpel signi?cantly reduces postoperative overall complications (?ap necrosis, and SSI) in the patient undergoing MRM
 Keywords: Flap necrosis, SSI, MRM

A study showing efficacy of harmonic scalpel over electrocautery in modified radical mastectomy

Background: The dissection in breast surgeries can be done using sharp scalpel and scissor dissection and high frequency electrocautery. Rarely, radiofrequency ablation and laser had been used in some limited trails. This study aims to prove the efficacy of harmonic scalpel over electrocautery in modified radical mastectomy operation.Methods: In this study, we included 40 patients with operable breast cancer. The patients were randomized into two equal groups by closed envelope technique to do modified radical mastectomy either using harmonic scalpel (group A) or using electrocautery (group B). The efficacy of two procedures were compared intraoperatively and postoperatively. The intraoperative parameters used were total time taken for surgery, time taken for axillary dissection, time for raising the flaps and time taken dissection of the breast tissue and the amount of blood loss. The post-operative parameters used were total drainage volume, days of drainage and seroma formation.Results: Our study showed use of harmonic sclalpel in modified radical mastectomy, resulted in reduction in total operating time (t= 4.037, p=0.00) as well as reduction in time taken for axillary dissection (t=3.66, p=0.001) and the amount of blood loss (t=3.02, p=0.00). The total drain volume (t=3.031, p=0.004) and the days of drainage (t=5.97, p=0.00) were also less with the harmonic scalpel dissection as compared to electrocautery.Conclusions: The use of harmonic scalpel in modified radical mastectomy shortens the operating time, axillary dissection time, amount of blood loss and drainage volume and drainage day and hence the hospital stay.

Is it really useful the Harmonic scalpel in axillary dissection for locally advanced breast cancer? A case series.

The seroma is one of the most common complications in the axillary lymph nodal dissection (different surgical approaches have been tried to reduce the seroma incidence). In our study we evaluate the outcome of patients using or not the ultrasonic scalpel (Harmonic scalpel) according to a standardized surgical technique. From January 2011 to December 2015 120 patients underwent axillary dissection for breast cancer. Patients were divided in two groups: patients belonging to the first group underwent Harmonic scalpel dissection and patients belonging to the second group underwent classical dissection. Each group consisted of 60 patients. Quadrantectomy (QUAD) was performed in 54 patients, 66 women underwent mastectomy. In all patients axillary dissection included the I, II and III level. We compared two groups in terms of: time of surgery, hematoma, drainage volume, days of sealing drainage, seroma formation, number of post-seroma aspirations, upper limb lymphedema, wound infections, post-operative pain. Statistically significant results were obtained in terms of the total volume of the breast and axillary drainage in the two techniques. There were no significant differences in the two samples in terms of operative time incidence of seroma, post-operative hematoma, wound infection, and lymphedema of the upper limb. The small number of cases did not allow us to reach definitive conclusions. The use of Harmonic scalpel seems to show smaller incidence of seroma and reduction of the amount of both breast and axillary drainages. Further studies are needed to define the real advantage in terms of cost benefit of using these devices in the axillary surgery.

Video-assisted thoracoscopic left upper lobe apical trisegmentectomy with the Harmonic scalpel.

Segmental resection is a useful procedure to preserve respiratory function. A 56-year-old woman presented with a finding of a left upper lobe lesion on CT scanning. She was performed video-assisted thoracoscopic left upper lobe apical trisegmentectomy with the Harmonic scalpel. Video-assisted thoracoscopy surgery (VATS) segmentectomy is associated with safe and feasible procedure. With the Harmonic scalpel dissection, blood loss is minimal and this speeds patient recovery.

Video-assisted thoracoscopic right lower lobectomy for lung cancer using the Harmonic scalpel.

A 68-year-old lady felt chest pain with tenderness of three years duration, who was a diagnosis of adenocarcinoma cell lung cancer. The accesses employed were based on the use of three ports through thoracoscope. With Harmonic scalpel all the hilar structures were isolated and separately sectioned, and systemic lymph node dissection was performed. Postoperative pathologic diagnosis was T2bN0M0 adenocarcinoma. Harmonic scalpel technique with video-assisted thoracoscopy surgery (VATS) has many advantages over traditional open thoracotomy and use of electrocautery for lobectomy in lung cancer surgery. Chief among these is greater patient safety. With Harmonic scalpel dissection, blood loss is minimal and this speeds patient recovery. It allows better visualization of key anatomic structures and permits better lymph node dissection, which is essential to reducing metastatic spread of the cancer.

Laparoscopic treatment of sigmoid diverticulitis: a retrospective review of 103 cases

Laparoscopic treatment of sigmoid diverticulitis is commonly accepted in Hinchey cases I and II, whereas it is debated in the case of purulent peritonitis, and not indicated for fecal peritonitis. A single-center experience of 103 patients treated for Hinchey I-III sigmoid diverticulitis was reviewed. One-stage laparoscopic resection and primary anastomosis constituted the planned procedure. Abscesses in patients with Hinchey IIa were drained percutaneously before surgery. Patients with Hinchey III underwent surgery in emergency. A four-trocar approach with left iliac fossa minilaparotomy was used. Fistulas were treated laparoscopically with Harmonic Scalpel dissection. Laparoscopic treatment was successfully completed for 100 patients. Intraoperative complications occurred in 2.9% of the cases. Postoperative procedure-related morbidity was 8%, occurring mainly in Hinchey I patients. A longer hospital stay was recorded among Hinchey IIb patients treated for colovescical fistula. No mortality was observed. Laparoscopic surgery for sigmoid diverticulitis in experienced hands can be a safe and effective gold standard procedure also for patients with fistula or purulent peritonitis.