Harmonic Scalpel Group Research Articles

Comparative Analysis of Monopolar Electrocautery and Ultrasonic Activated Scalpel in Laparoscopic Cholecystectomy: A Comprehensive Evaluation Using Clinical, Laboratory, and Imaging Techniques.

Introduction Laparoscopic cholecystectomy has long been the cornerstone of gallstone treatment. Both monopolar cautery and ultrasonically activatedscalpel(UAS, also known as harmonic scalpel) have been employed in the dissection of the gallbladder from its fossa during laparoscopic cholecystectomy. Material and methods The prospective study was conducted in the Department of Surgery at Vivekananda Institute of Medical Sciences including 200 patients equally divided among the monopolar cautery and harmonic scalpel group. Patients were observed for 48 hours post-surgery, during which temperature and pain assessment were done. Acute phase reactants were measured during this period and compared with preoperative values. On the seventh day ultrasonography was done to look for the inflammatory changes. Results In a study involving 200 patients, the majority fell within the age bracket of 31 to 50 years, with females constituting the predominant demographic. Notably, patients who underwent surgery with a harmonic scalpel exhibited a reduced need for analgesics. Furthermore, the use of harmonic scalpels led to noteworthy alterations in acute phase reactants, including a significant decrease in the total leucocyte count (TLC) (p=0.03), neutrophils (p=0.005), and lymphocytes (p=0.02). Additionally, patients in the UAS group experienced a significantly lesser increase in erythrocyte sedimentation rate(ESR) and C-reactive protein (CRP) values (p=0.0001). Conversely, ultrasound imaging conducted on the seventh day post-surgery did not reveal any significant differences between the two groups. Conclusion Laparoscopic cholecystectomy performed with a harmonic scalpel is associated with a reduced tissue response and less tissue damage compared to the monopolar group.

Harmonic scalpel versus conventional hemostasis: Impacts on thyroid surgery outcomes

Objectives: This study aimed to compare the effectiveness and safety of the harmonic scalpel and traditional methods. Patients and Methods: In this retrospective study data from 180 patients (132 females, 48 males; mean age: 49.1±14.2 years; range, 18 to 86 years) who underwent total thyroidectomy between January 2015 and December 2022 were analyzed. Age, sex, diagnosis, thyroid size, operative time, hospital stay, and complications were recorded. The patients were divided into two groups based on the hemostasis method: harmonic scalpel and conventional methods. All surgeries were performed under general anesthesia with the same surgical teams. Results: The harmonic scalpel group demonstrated a lower incidence of hypocalcemia and shorter operation times compared to the conventional method group. No significant differences were found in vocal cord paralysis, hematoma, seroma, and wound infection rates between the groups. The harmonic scalpel was associated with a shorter mean hospital stay. Conclusion: The harmonic scalpel presents itself as a viable alternative in thyroid surgery, offering shorter operation times and hospital stays with a reduced rate of hypocalcemia.

Comparing the outcomes of total thyroidectomy using a harmonic scalpel versus the conventional ligation techniques in Iran

Background: Maintaining hemostasis is considered a remarkable challenge during total thyroidectomy. The use of thermal ultrasonic electrocoagulation (harmonic scalpel) for total thyroidectomy was recently introduced to substitute the conventional ligation methods. However, controversies exist on the efficacy of this technique compared to the classic method.
 Methods: The data regarding this prospective cohort study was gathered between March 2019 to March 2020. Ninety participants were enrolled in the study. Forty-five subjects received harmonic scalpel ligation and the other forty-five participants underwent conventional total thyroidectomy. Afterward, these two groups were statistically compared regarding surgical time, postoperative hypocalcemia, drainage volume, postoperative pain, hospital stay, and recurrent nerve damage.
 Results: No significant difference was detected in the group undergoing harmonic ligation concerning postoperative pain, postoperative hospital stay, drainage volume, and postoperative hypocalcemia in the first 48 hours post-operation. However, using a harmonic scalpel significantly reduced the surgical time (56 ± 2 minutes in the harmonic scalpel group versus 67 ± 9 in the conventional technique group, p < 0.001). Also, no recurrent nerve damage was detected in the study.
 Conclusions: Utilizing a harmonic scalpel has a remarkably higher time efficacy in total thyroidectomy. However, the study suggests no further advantage for this method compared to the conventional techniques in total thyroidectomy.

Harmonic Scalpel Versus Monopolar Electrotome in Endoscopic-Assisted Transaxillary Dual-Plane Augmentation Mammaplasty: A Retrospective Study in 122 Patients.

The transaxillary approach of breast augmentation is the most popular method in Asia, but longer period of recovery was observed in spite of the assistance of endoscope. Introducing the ultrasonic dissection devices might be a solution to minimizing tisue damage thus relieving pain and shortening the period of recovery. Between March 2020 and September 2022, we retrospectively reviewed the cases of 122 patients underwent endoscopic augmentation mammoplasty via the transaxillary approach using either the monopolar electrotome (ME) alone or assisted with Harmonic Scalpel (HS) in defining the retropectoral pocket and severing the pectoralis major muscle. The total drainage volume was significantly lower in the HS group than ME group (74.33 ± 48.81 vs. 180.30 ± 125.10 mL; p < 0.0001). VAS score of the first 24 hour after surgery of the ME group was significantly higher than that of the HS group (6.10 ± 1.27 vs. 2.88 ± 1.29, p < 0.0001). Operation time in HS group was reduced compared to ME group (113.1 ± 14.46 mins vs. 131.3 ± 35.51 mins, p < 0.001). The duration of drainage placement (1.08 ± 0.27 vs. 2.72 ± 1.18 days) and hospital stay after surgery (3.08 ± 0.42 vs. 5.64 ± 2.78 days; p < 0.0001) were largely reduced in HS group. The assistance of Harmonic Scalpel significantly reduced total postoperative drainage, relieved pain and shortened operation time, length of drainage placement and hospital stay compared to using monopolar electrotome alone in endoscopic-assisted transaxillary dual-plane augmentation mammaplasty. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Comparison of 980-nm/1470-nm Dual-Wavelength Fiber Laser Versus Ultrasonic Scalpel Device in Open Thyroidectomy.

Background: To investigate the application value of 980-nm/1470-nm dual-wavelength fiber laser in thyroidectomy. Methods: The clinical data of 130 patients undergoing thyroid surgery from March 2017 to December 2018 were retrospectively analyzed. According to the use types of energy devices, the patients were divided into laser group and ultrasonic scalpel group, with 65 patients in each group. The baseline data, operation-related indicators, operation complications, postoperative pathological conditions, and follow-up results of the two groups were compared. Results: The operations were successfully completed in both groups. The median operative time of total thyroidectomy (TT), lobectomy+central lymph node dissection (CLND), TT+CLND in the laser group were longer than that in the harmonic scalpel group, and the difference was statistically significant (p < 0.05). The incidence of parathyroid gland congestion in the laser group (10.3%) was lower than that in the harmonic scalpel group (19.2%), and the difference was statistically significant (p < 0.05). No significant differences were found in operative type, intraoperative blood loss, postoperative drainage volume, operative complications, postoperative hospital stay, and lymph node metastasis rate between the two groups (p > 0.05). No incidence was noted of recurrence, metastasis, or death in both groups. Conclusions: The 980-nm/1470-nm dual-wavelength fiber laser had an efficacy in open thyroidectomy similar to that of the harmonic scalpel, was safe and feasible, and less damage to the parathyroid gland blood supply than a scalpel. It can be used as a new option for thyroid surgery.

Comparison of Total Thyroidectomy with Ligasure Small Jaw Device and Harmonic Scalpel

Objective: To compare our experience with the LigaSure small jaw device and Harmonic scalpel in total thyroidectomy regarding operative time and major complications associated with surgery.&#x0D; Study Design: Prospective comparative study.&#x0D; Place and Study Duration: General Surgery Department, Pak Emirates Military Hospital, Rawalpindi and Combined Military Hospital, Kohat Pakistan, from Oct 2017 to Apr 2020.&#x0D; Methodology: This study included 150 patients diagnosed with simple/toxic multinodular goitre, thyroid carcinoma, and diffuse thyroid enlargement. Eighty-one patients were randomly assigned to the LigaSure Group and 69 to the Harmonic Group who underwent total thyroidectomy. Mean operative time and major complications like blood loss, hematoma, hypocalcemia, recurrent laryngeal injury, and surgical site infection were compared.&#x0D; Results: Median (IQR) operative time of the LigaSure small jaw device was 55.00(11) minutes, and that of the Harmonic scalpel was 60.00 (11) (p&lt;0.001). The postoperative hematoma formation in the LigaSure small jaw device was 1(1.2%), and that in the Harmonic scalpel Group was 0(0%) (p=0.35). There was no bilateral nerve injury in both Group. The percentage of hypocalcemia (second postoperative day to seventh postoperative day) in the LigaSure small jaw device was 2(2.5%), and that in the Harmonic scalpel Group was 2(2.9%) (p=0.9). &#x0D; Conclusion: The mean operative time of Thyroid surgery with a LigaSure small jaw device is less than that with a Harmonic scalpel. There is no difference in intraoperative blood loss and postoperative complications between them.

Comparison of the effect of the harmonic scalpel and monopolar cautery in transaxillary endoscopic dual-plane breast augmentation

Transaxillary endoscopic dual-plane breast augmentation is becoming increasingly mature. The intraoperative separation of the implant into the space is often performed using monopolar cautery. The use of the harmonic scalpel has proved more beneficial in several surgeries. However, no study has ever addressed the effects of harmonic scalpel usage compared to monopolar cautery in transaxillary endoscopic dual-plane breast augmentation. In this randomized controlled study, we enrolled patients (n=78) who underwent breast augmentation in our hospital from January to October 2022. Participants were randomized with an intentional unequal allocation ratio (2:1 in the harmonic scalpel group: monopolar cautery group). Outcome measures included: total postoperative drainage volume, postoperative drainage volume for the first 24h, number of postoperative drainage days, daily pain scored through the visual analog scale, operative time, and reoperation rate. A total of 51 patients in the harmonic scalpel group and 24 patients in the monopolar cautery group were analyzed. Overall, in comparison to the monopolar cautery group, the harmonic scalpel group showed improved total postoperative drainage volume, postoperative drainage volume for the first 24h, number of postoperative drainage days, and postoperative pain scores. No differences were found regarding operative time and reoperation rate. Compared with monopolar cautery, harmonic scalpel usage in transaxillary endoscopic breast augmentation has evident advantages regarding postoperative drainage and patients' pain scores, making it an instrument worth of recommendation.

Harmonic Scalpel versus Electrocautery and its Outcome in Laparoscopic Cholecystectomy: A Prospective Interventional Study

Introduction: Laparoscopic cholecystectomy can now be performed safely and effectively due to various surgical tools that have significantly reduced intraoperative and postoperative problems. The Harmonic® Scalpel (HS) is a superior option to more conventional Electrocautery (EC) because it reduces temperatures, smoke, and lateral tissue damage. The Harmonic® Scalpel also lowers the risk of injury due to minimal heat dispersion. Due to less trauma, there is a decrease in both moderate and severe bleeding. It is hypothesised that the HS might be a more cost-effective alternative to employing a variety of disposable tools, such as scissors, a clipper, an EC hook, and a grasper. Aim: To compare the effectiveness and safety of the HS compared to traditional EC in achieving complete dissection and haemostasis during laparoscopic cholecystectomies. Materials and Methods: A prospective interventional study was conducted with 300 patients diagnosed with chronic calculous cholecystitis, admitted to a tertiary care hospital under Department of General Surgery, from November 2020 to October 2022. Patients were allocated to two groups, and the outcomes of laparoscopic cholecystectomy were compared between the usage of a HS and EC in Calot’s triangle dissection and Gallbladder (GB) dissection from the GB fossa. Descriptive data were represented through frequencies and percentages. The means of the two groups were compared using t-test, and categorical variables were compared using chi-square test. Results: The mean age was 46.53±13.740 years in the HS group, while it was 45.3±13.961 years in the EC group. The average duration of dissection with a HS was 52.84±6.167 minutes and 56.79±5.582 minutes in the EC group (p-value 0.001). A total of 67 (44.7%) patients in the HS group had minimal or no bleeding, while it was 23 (15.3%) patients in the EC group. GB perforation occurred in 13 (8.7%) patients in the HS group and in 26 (17.3%) patients in the EC group. Liver injury occurred in 2 (1.3%) patients in the HS group and in 6 (4%) patients in the EC group. Postoperative nausea and vomiting were reported in 20 (13.3%) and 72 (48%) patients in the HS and EC groups, respectively, in the first 48 hours. All these associations were found to be statistically significant (p-value 0.001). Conclusion: The present study found that the HS offers a hassle-free dissection without much incidence of intraoperative bleeding or surrounding tissue damage.

Novel application of microdissection tungsten needle in total thyroidectomy with central neck dissection for papillary thyroid carcinoma.

BackgroundEnergy-based devices (EBD) have been popularized in thyroidectomy worldwide. Microdissection tungsten needle (MDTN) is characterized by the ultra-sharp tip providing safe and meticulous dissection with effective hemostasis. However, little study has applied MDTN in thyroidectomy.MethodsThis retrospective study compared clinical data of the patients who underwent total thyroidectomy (TT) with central neck dissection (CND) using MDTN, harmonic scalpel (HS), and conventional electrocautery (CE). We assessed outcomes related to surgical efficacy and safety. The injury degree of tissue was assessed by biochemical indicators and early-stage inflammatory factors in the drainage fluid. Histological sections of the thyroid specimens were evaluated to compare levels of thermal damage by the three EBD.ResultsThere was a significant decrease in the intraoperative blood loss, operation time and 24-hour drainage volume in the MDTN group compared to the CE group. The total drainage volume, duration of drainage, and average length of stay of the MDTN group were less compared to the CE group though they did not reach statistical significance. No disparity was observed between the MDTN group and HS group in these variables. Total costs were not significantly different among these groups. The incidence of recurrent laryngeal nerve (RLN) injury was the lowest using MDTN compared to the CE (P = 0.034) and HS (not significant). No statistical differences were observed among these groups regarding postoperative wound pain and infection, hypoparathyroidism, and postoperative hemorrhage. Analysis of biochemical indicators showed a lower level of hemoglobin in the MDTN and HS group than the CE group (P = 0.046 and 0.038, respectively) and less triglyceride in the HS group than the MDTN and CE group (P = 0.002 and 0.029, respectively) but no significant difference in cholesterol level in these groups. Early-stage inflammatory factors including TNF-α and IL-6 showed significantly higher concentration in the CE group than the MDTN and HS group. Histological sections of thyroid specimens revealed that MDTN caused the lowest degree of thermal damage followed by HS then CE. ConclusionMDTN exhibited comparable surgical efficacy and safety outcomes as HS in thyroidectomy. Therefore, MDTN is a safe and viable alternative for hemostasis in thyroidectomy.

Comparison Between Harmonic scalpel and Cold dissection in Tonsillectomy at Shree Birendra Hospital: A Retrospective Study

Introduction: Tonsillectomy is the most common surgery performed by otorhinolaryngologist worldwide. It is a surgical procedure of removing tonsil with commonest indications for recurrent tonsillitis and tonsillar hypertrophy. The two most important complications of this surgery are bleeding (intraoperative, postoperative) and postoperative pain. Various surgical techniques have been developed to minimize this complication. Harmonic scalpel is an ultrasonically activated surgical device which can coagulate and cut vessels and tissues at a very low temperature. This study was conducted to compare the operative time, intraoperative blood loss and early post-operative pain between Harmonic scalpel and cold dissection tonsillectomy. Methods: This was a retrospective study conducted in ENT and Head and Neck Surgery department of Shree Birendra Hospital, Chhauni, Kathmandu from July 2018 to July 2019. Each patient was assessed by ENT Head and Neck Surgeon. Clinically diagnosed recurrent tonsillitis and tonsillar hypertrophy were included in the study. Those with age &lt; 14 years, acute infection, obstructive sleep apnoea syndrome, adenoid hypertrophy, nasal pathology, cleft, history of bleeding disorders, inability to give informed consent, individual who would have difficulty communicating their pain levels, any chronic illness was excluded. Results: Out of 50 patients, 33(66%) were males and 17(34%) were females. The operative blood loss in harmonic scalpel was lesser (21.89 ± 8.89 ml) than in cold dissection group (49.74 ± 19.69 ml) which was statistically significant (p value = 0.000). The operating time in harmonic scalpel group was longer (8.48 ± 4.58 minutes) than in cold dissection group (8.14 ± 2.01 minutes). Pain on the early postoperative period (3 hours post-surgery, 1st and 2nd postoperative day) was lesser in harmonic scalpel group 68% (34/50) than in cold dissection group 32% (16/50). Conclusion: Harmonic scalpel is easy to use instrument which reduces intra-operative blood loss and post-operative pain as compared with cold dissection method.

Harmonic Scalpel versus Electrocautery: An Experience of Modified Radical Mastectomy at Tertiary Care Teaching Hospital

Background: The harmonic scalpel, commonly used in laparoscopic surgery, now has promise for MRM dissection. The harmonic scalpel's high frequency mechanical vibrations cut and coagulate intraoperatively at the same time, generating less heat injury than electrocautery.&#x0D; Objective: To compare the outcome of modified radical mastectomy using harmonic scalpel versus electrocautery at tertiary care teaching hospital.&#x0D; Methodology: The randomized controlled trial was conducted from 12th September 2018 11th March 2019 at Department of Surgery, Liaquat University of Medical and Health Science, Jamshoro. A total of 128 patients with infiltrating ductal carcinoma undergoing modified radical mastectomy, 20 to 50 years of age were included. Chronic Hepatitis, diabetes, and neo-adjuvant treatment patients were excluded. Modified radical mastectomy employing harmonic scalpel for Group A and electrocautery for Group B. Postoperative problems such as seroma development, postoperative hematoma, marginal necrosis, lymphedema, and wound infection were also observed.&#x0D; Results: The mean age of women in group A was 39.81 ± 6.73 years and in group B was 39.45 ± 6.60 years. Mean duration of disease was 5.41 ± 1.91 months. The frequency of seroma formation in harmonic scalpel group as 7.81% vs 26.56% in electrocautery group, p=0.005), frequency of pain is 53.13% vs 68.75% respectively, p=0.070, frequency of hematoma is 1.56% vs 17.19% respectively, p=0.002), frequency of marginal necrosis was 0.0% vs 7.81% respectively, p=0.023), lymphedema 3.13% vs 14.06% respectively, p=0.027) and wound infection 17.19% vs 35.94% respectively, p=0.016.&#x0D; Conclusion: This research indicated that harmonic scalpel is superior to electrocautery in modified radical mastectomy.

Comparison of Conventional Bipolar Electrocautery and Ultrasonic Harmonic Scalpel in Colorectal Cancer Surgeries.

Background and objectiveColorectal cancer (CRC) is the third most common malignancy and the second most deadly cancer worldwide. Powered equipment has transformed modern surgery, revolutionizing the delicacy, precision, and accuracy of many surgeries. The safety and efficacy of tissue dissection and artery sealing in colorectal surgery remain highly debatable. With the increased use of minimally invasive procedures in colon and rectal surgery, energy devices for tissue dissection and vascular sealing have become widely used. In light of this, we aimed at comparing the use of bipolar electrocautery and harmonic scalpel in CRC surgeries.MethodsOur study was a hospital-based comparative study conducted at our tertiary care hospital. Fifty patients were divided equally into two groups by block randomization, and bipolar electrocautery was used in one group, and harmonic scalpel was used in the second group during surgery. The mean operative time, blood loss, and hospital stay were calculated in both groups. The comparison between bipolar electrocautery and harmonic scalpel was evaluated using independent t-tests.ResultsThe mean operative time, blood loss, and hospital stay were significantly lower in the harmonic scalpel group than in the electrocautery group. The results were statistically significant (p < 0.001).ConclusionBased on our findings, the harmonic scalpel is a better energy source when compared to bipolar electrocautery in CRC surgeries.

Comparison of Seroma Formation with Harmonic Scalpel Versus Monopolar Electrocautery in Axillary Dissection following Modified Radical Mastectomy

Background: Breast cancer is cancer that forms in the cells of the breasts. Despite of the emergence of the breast conservation technique modified Radical Mastectomy still remains the most commonly performed surgery for CA Breast. The Harmonic scalpel is a surgical instrument used to simultaneously cut and cauterize tissue. Aim: To compare the frequency of seroma formation with harmonic scalpel versus monopolar electrocautery in axillary dissection following modified radical mastectomy. Methods: This randomized control trial was conducted in the Department of General Surgery, Lahore General Hospital and Ghurki Trust Teaching Hospital, Lahore. 60 patients were enrolled. Two groups were made by applying lottery method. One group is treated with hormonic scalpel and other with electrocautery. All surgeries were done under general anesthesia by two surgical teams. After surgery, patients shifted in post-surgical wards and will be followed- up there for 7 days. Seroma formation was noted. All the collected data was entered and analyzed on SPSS version 21. Results: The mean age in harmonic scalpel group was 49.87± 8.67 years and in electrocautery group was 49.87± 8.67 years. The seroma formation in harmonic scalpel group was noted in 5(16.7%) patients whereas the seroma formation in electro cautery group was found in 11(36.7%) patients (p-value=0.080). Conclusion: This study concluded that the harmonic scalpel group showed lower rate of seroma formation than to electrocautery group, however statistically both groups are equally effective Keywords: Harmonic Scalpel, Seroma Formation, electrocautery

A comparison of the harmonic scalpel, coblation, bipolar, and cold knife tonsillectomy methods in adult patients

Background/Aim: Tonsillectomy is one of the widely performed surgical procedures by otolaryngologists. Today, many new surgical instruments are used in tonsil surgery to reduce postoperative morbidity. This study aimed to compare intraoperative blood loss, operating time, postoperative pain, and bleeding between harmonic scalpel tonsillectomy, coblation tonsillectomy, bipolar tonsillectomy, and cold dissection tonsillectomy in adult patients. Methods: This prospective cohort study population comprised 96 adult patients aged 18-60 years (mean age: 34.9 (10.7) years) who were operated on for chronic tonsillitis. The amount of bleeding and the operation time were calculated intraoperatively. Postoperative pain level was evaluated using a Visual Analogue Scale (VAS) at the sixth postoperative hour and on postoperative days 1, 2, 3, and 7. Results: In the harmonic scalpel group, the mean volume of intraoperative bleeding (2.7 (1.5) ml) and the mean operation time (8.8 (3.0) min) were significantly lower compared to the other groups (P

Comparative Study between Hemorrhoidectomy with Harmonic Scalpel Versus Electrocautery

Abstract Background: Hemorrhoidal disease is a very prevalent disorder that arises from engorgement of internal and/or external vascular plexuses surrounding the anal canal. Hem-orrhoidectomy is the standard treatment for grade III or grade IV internal hemorrhoids; in spite of this, pain after conventional hemorrhoidectomy is still a major challenge. Aim of Study: To compare the outcome of hemorrhoidec-tomy using Harmonic scalpel without ligation of the pedicle versus electrocautery with ligation of the pedicle as regarding cost, operative time, post-operative bleeding, pain, and healing process. Patients and Methods: This study was a prospective, clinical, randomized, trial that included 50 patients grade III internal hemorrhoids with external components or grade IV disease. The patients were divided into two groups: Group I that included 25 patients underwent electrocautery with ligation of the pedicle and Group II which included 25 patients under-went Harmonic scalpel hemorrhoidectomy without ligation of the pedicle. Results: There was statistically significant association between type of procedure and operative time (p=0.001). Patients who underwent Harmonic scalpel hemorrhoidectomy had statistically significant lower pain score at day 1, 3, 7, 15, and 30. There was statistically significant association between type of procedure and time to heal (p=0.001). Patients who underwent Harmonic scalpel hemorrhoidectomy had statistically significant shorter time to complete healing. On the contrary, there was statistically significant association between type of procedure and hospital stay (p=0.18). There was statistically significant association between type of procedure and late complications (p=0.001). Patients who underwent Harmonic scalpel hemorrhoidectomy had statisti-cally significant less incidence of late complications. Conclusion: It is concluded that there was significantly reduced post-operative pain after Harmonic Scalpel hemor-rhoidectomy compared with electrocautery controls. The diminished post-operative pain in the Harmonic Scalpel group likely results from the avoidance of lateral thermal injury.

To Compare the Dissection of Gallbladder by Ultrasonic Harmonic Scalpel Versus Electrocautery in Laparoscopic Cholecystectomy

Objectives: To assess the dissection of gallbladder by ultrasonic harmonic scalpel in comparison to electrocautery in laparoscopic cholecystectomy. Study Design: A randomized control trial Study Setting and Duration: Department of Surgery Ward-02 Jinnah Postgraduate Medical Centre, Karachi between June 2018 and February 2019. Methodology: A total of 110 patients diagnosed with cholelithiasis were included in the study. The participants were randomly allocated into two groups i.e., harmonic scalpel group and electrocautery group. Patients were followed postoperatively in the ward and the outcome was measured at the end of two days after surgery. Results: The average age of the patients was 44.56 ± 12.19 years. Out of 110 patients, 30 (27.3%) were male and 80 (72.7%) were female. It was found that the mean operative time (44.4 ± 3.64 min vs. 53.31 ± 8.09 min; p=0.0005), blood loss (10.27 ± 8.35ml vs. 4.00 ± 3.65ml; p=0.0005), post-operative pain (6.87 ± 1.04 vs. 4.29 ± 1.01 p=0.0005), and hospital stay (31.09 ± 10.58 vs. 24.11 ± 0.81; p=0.0005) were significantly lower in harmonic scalpel group than the electrocautery group. Conclusion: Dissection of gall bladder with harmonic scalpel is safe and easy method and superior then electrocautery and can routinely be used if available. Keywords: Laparoscopic cholecystectomy, Harmonic scalpel, Electrocautery

Comparison of Outcome of Bipolar Electrocautery versus Harmonic Scalpel in the Management of Third and Fourth Degree Hemorrhoids

Objective: To compare the outcome of bipolar electrocautery versus harmonic scalpel in the management of third degree hemorrhoids.&#x0D; Methodology: This is a comparative study performed at Different Private Clinics of Karachi from the duration of January 2020 to June 2020. Patients with symptomatic grade III hemorrhoids and grade IV hemorrhoids were randomly divided into two groups. . Either group had 64 patients. One group underwent hemorrhoidectomy using bipolar electrocautery (Group A), other group underwent hemorrhoidectomy using harmonic scalpel hemorrhoidectomy (Group B).&#x0D; Results: The total number of patients was 128 with 64 in either group. The mean operating time in group A was 22 ± 4.7 minutes, while that in group B was 35 ± 2.2 minutes. The mean duration of hospital stay among group A was 1.7 ± 0.5 days while among group B patients was 2.1 ± 1.2 days. Mean VAS score for pain at first post-operative day in group A patients was 7 ± 0.6 days while mean VAS score for pain among group B patients was 8.5 ± .2 days.&#x0D; Conclusion: Our study concludes that harmonic scalpel hemorrhoidectomy offers better post-operative patient satisfaction score as compared to bipolar diathermy. No significant difference in hospital stay was found. The number of patients with post-operative urinary retention were more in harmonic scalpel group while in diathermy group, more patients had post-operative hemorrhage.

Harmonic scalpel versus traditional scissors in laparoscopic partial nephrectomy: A propensity score-based analysis

ObjectiveThe present study aims to compare the clinical efficacy of laparoscopic partial nephrectomy using a harmonic scalpel versus traditional scissor. MethodsA retrospective review was conducted in patients with localized renal tumors and scheduled for laparoscopic partial nephrectomy from January 2015 to December 2019. Eventually, 225 patients joined this retrospective study. Patients were divided into the harmonic scalpel group or scissor group based on the method used, with 71 cases and 154 cases respectively. Propensity score matching (1:1) was performed to adjust for potential baseline confounders, and each group had 57 cases. Patient characteristics, perioperative clinical results, complications, and oncological results were compared between the two groups. ResultsAfter matching, patient characteristics were not significantly different between the two groups. The scissor group was associated with a significantly shorter operative time (105 min vs. 130 min, p < 0.001), shorter warm ischemia time (19.35 min vs. 22.07 min, p = 0.005). However, the harmonic scalpel group was associated with significantly less estimated blood loss (20 mL vs. 30 mL, p = 0.013) and shorter length of stay (8 d vs. 10 d, p = 0.040). There was no significantly difference in indwelling time of drainage tube, perioperative complication, oncological outcomes or recurrence rates. ConclusionsThe harmonic scalpel is used safely and effectively in laparoscopic partial nephrectomy, and has benefits in intraoperative blood loss and length of stay.

Harmonic scalpel thyroidectomy versus conventional haemostasis thyroidectomy

Background: As there is paucity of data on harmonic scalpel thyroidectomy from Jammu and Kashmir belt. So, we conducted this study to bridge this gap and also to create awareness about the use of harmonic scalpel. Thyroidectomy has become one of the most common and frequent surgery. Hemostasis in thyroid surgery is of utmost importance for a successful surgery. Our aim was to compare operative factors, postoperative outcomes of thyroidectomy using the Harmonic Scalpel (HS) and Conventional Haemostasis (CH).Methods: In this randomized control trial study, 100 patients who underwent thyroidectomy were enrolled and randomly divided in two groups- HS group and CH group. The inclusion criteria were age&gt;18years, acceptance to participate in the study (signed informed consent form) and scheduled total thyroidectomy. The groups were compared with regards to age, gender, operative time, post-operative drainage volume, postoperative pain, and hospital stay.Results: The mean age in years was 39.8 years for HS group and 43.8 years for CH group with female preponderance. There was a significant difference with regards to operative time, post-operative drainage volume, postoperative pain, and hospital stay (p&lt;0.001). Harmonic Scalpel shortens the operative time. And there was less post-operative drainage volume and postoperative pain in HS group. Hospital stay was also less as compared to CH group.Conclusions: HS is superior then CH thyroidectomy and is considered as a safe and better tool in thyroidectomy.

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.