Harmonic Scalpel Research Articles (Page 1)

Introduction: Tissue-mimicking materials play an integral role in clinical education through providing a controlled, risk-free environment for skill development. While commercially available phantoms enhance trainee proficiency and patient safety, their high cost and limited accessibility hinder widespread adoption. Consequently, clinical training often relies on supervised practice, constrained by logistical challenges and patient safety concerns. To address these limitations, ADAMgel was developed as a low-cost, non-toxic, and recyclable biomaterial designed to replicate human tissue properties [1]. Its successful integration into procedural training models highlights its potential as an effective simulation medium. ADAMgel offers several advantages, including versatility, affordability (<£2/kg), self-healing properties, bacterial resistance, and compatibility with diathermy and harmonic scalpels. Additionally, it closely mimics human tissue under ultrasound imaging, making it particularly valuable for sonography-based training. However, a lack of comprehensive mechanics data has restricted broader implementation in medical training. This study systematically evaluates the mechanical properties of six ADAMgel formulations to refine their suitability for simulation applications. Methods: Six formulations were prepared with varying concentrations of psyllium husk, glycol, antifoam, water, and gellan gum to assess their impact on mechanical performance. Each underwent standardised tests, including Ultimate Tensile Strength, Young’s modulus in both tensile and compression modes, and durability evaluations. All tests were conducted in triplicate to ensure statistical reliability on the 15/01/24, with data incorporated into mathematical models for analysis. Results: A controlled preparation protocol ensured consistency, facilitating reproducible comparisons. Mechanical properties varied significantly across formulations. V5 exhibited the highest ultimate tensile strength (1308.12 Pa) and compressive resistance (6540.60 Pa), indicating superior load-bearing capacity. In contrast, V1 demonstrated the lowest tensile resilience (687.5 Pa), reinforcing the inverse correlation between increased water content and structural integrity. Young’s modulus in tension revealed that V4 was the most rigid (4216.03 Pa), while V1 and Standard formulations displayed greater elasticity. Durability testing indicated no material degradation following cyclic loading, supporting ADAMgel’s durability for repeated use. Gum-based formulations (V5, V4) demonstrated enhanced mechanical stability, whereas lower-viscosity variants (V1, V3) showed greater deformability, making them suitable for applications requiring flexibility. The incorporation of gellan gum (V5) significantly improved tensile properties, highlighting its potential for load-bearing applications in surgical training. Discussion: These findings underscore ADAMgel’s adaptability and provide empirical data for optimising formulations to better mimic specific tissue types. Future research should focus on refining ADAMgel’s composition to bridge the gap between synthetic and biological tissue properties, further enhancing its efficacy in procedural training models. Ethics Statement: As the submitting author, I can confirm that all relevant ethical standards of research and dissemination have been met. Additionally, I can confirm that the necessary ethical approval has been obtained, where applicable.

Background. Hemostasis during thyroid surgery is critical for achieving satisfactory outcomes and ensuring a smooth postoperative recovery. For open thyroidectomy operations, the ergonomically constructed Focus Harmonic (FH) shears are the way to go. They make incisions, coagulation, and dissection easier. The purpose of the study is to compare the FH scalpel with conventional hemostasis (CH) in terms of operational duration, length of hospital stays, drainage volume, and surgical complications in open total thyroidectomy. Materials and methods. In this study, 120 patients were randomly assigned to one of two groups based on the surgical technique. Patients in group 2 were more often treated using the FH scalpel, in contrast to group 1 who underwent the conventional clamp-and-tie technique. The groups were assessed based on the following variables: drainage volume, length of hospital stay, number of problems, and duration of surgery. Results. The comparison of operating time indicated that the mean duration of surgery was considerably reduced in the FH group (71.3 ± 11.1 minutes) compared to the CH group (85.7 ± 15.5 minutes) (P < 0.001). The drainage volume in the Focus group was substantially lower than in the conventional group, measuring 38.0 ± 14.4 cc compared to 58.6 ± 23.7 cc, respectively (P < 0.001). The length of hospital stay was markedly prolonged in the CH group, averaging 28.2 ± 11.3 hours, in contrast to 20.4 ± 4.3 hours in the FH group (P < 0.001). In complete thyroidectomy, our findings indicate that the FH approach is more successful than the CH procedure. The surgery duration is reduced, total drainage fluid volume is diminished, and hospital stay is shortened, with no significant impact on recurrent laryngeal nerve or temporary symptomatic hypocalcemia. The Focus Harmonic scalpel is considered a safe and dependable device compared to the clamp-and-tie procedure in complete thyroidectomy. Conclusions. The Focus Harmonic scalpel may reduce operation duration, hospital length of stay, and drainage volume. It is deemed a safe and dependable device compared to the clamp-and-tie approach in complete thyroidectomy.

Endoscopic-assisted transaxillary dual-plane augmentation mammaplasty is favored for its aesthetic advantages and minimal visible scarring. However, the optimal dissection tool between harmonic scalpel (HS) or monopolar electrotome (ME) remains debated due to limited comparative data. A systematic review and meta-analysis were conducted by searching PubMed, Embase, and Cochrane Library for studies comparing HS and ME in endoscopic-assisted transaxillary dual-plane augmentation mammaplasty. Data synthesis was performed using Review Manager 5.4 with random-effects models. Clinical outcomes were pooled as mean differences (MD) or odds ratios (OR) with 95% confidence intervals (CI). Heterogeneity was assessed using the I2 statistic. Four studies comprising 390 participants met the inclusion criteria. HS significantly reduced total drainage volume (MD -113.40 mL; 95% CI -133.82 to -92.97; I2 = 10%), duration of drainage (MD -1.34 days; 95% CI -1.69 to -0.98; I2 = 64%), VAS pain scores within the first 24 hours (MD -2.25; 95% CI -3.53 to -0.98; I2 = 94%), and hospital stay (MD -1.90 days; 95% CI -3.90 to -0.71; I2 = 89%) compared to ME. Differences in operative time and bleeding were not statistically significant. HS offers superior outcomes over ME in terms of drainage, pain control, and hospitalization following endoscopic-assisted transaxillary dual-plane augmentation mammaplasty. These findings support the preferential use of HS, though larger, high-quality trials are warranted. Trial Registry The study protocol was prospectively registered on PROSPERO (CRD42025639891). 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 .

IntroductionThyroidectomy is one of the most commonly performed surgeries around the world. Historically, it was a high-mortality procedure. However, this is not the case today due to advances in surgical technique and instruments. In particular, advanced energy devices such as LigaSure™ (Medtronic, Minneapolis, MN, USA) and Harmonic scalpel (Ethicon, Raritan, NJ, USA) have revolutionised thyroid surgery by enhancing precision and minimising blood loss. These devices are indispensable in most settings. However, in many low- and middle-income countries (LMICs), their high cost and limited availability pose significant barriers to their widespread adoption.Standard bipolar forceps, on the other hand, is widely available in many LMIC settings and is significantly cheaper. In this study, we investigate the safety profile of using standard bipolar forceps in thyroid surgery. This study aimed to investigate the rates of the two most common complications post-thyroidectomy, namely, hypocalcaemia and recurrent laryngeal nerve (RLN) injury. Methods A prospective observational study of 178 patients undergoing total thyroidectomy for multinodular goitre was conducted at a single centre in Kerala, India. Postoperatively, all patients were evaluated for hypocalcaemia and RLN injury at six hours and then monthly for six months. Complications persisting at six months were deemed permanent. Any symptoms that resolved before six months were classified as temporary.ResultsThe mean age was 40.8 years, 84/178 patients had symptoms lasting more than a year, and 156/178 patients had at least one nodule measuring ≥3 cm. Out of 178 patients, 118 were female and 60 were male.Around 18.5% (33/178) of patients developed temporary hypocalcaemia. However, only one patient had permanent hypocalcaemia. About 5.1% (9/178) of patients developed temporary RLN injury, and none of the patients had permanent RLN injury. One patient developed a wound infection, and the mortality rate was 0%.Conclusion This study outlines the outcomes of employing bipolar forceps for thyroid surgery, highlighting its potential as a safe and cost-effective substitute for advanced energy devices in low-resource settings.

Introduction: Conventional excisional hemorrhoidectomy, while effective for high-grade hemorrhoids, is frequently associated with significant postoperative pain and a prolonged recovery period. Newer modalities, such as stapled hemorrhoidopexy and energy-based devices, have been developed to minimize trauma and improve patient outcomes. This systematic review provides a comprehensive comparative analysis of these surgical techniques, focusing on postoperative complications and patient recovery metrics. Methods: Following the PRISMA 2020 guidelines, a systematic search was conducted across PubMed, Semantic Scholar, Springer, and Google Scholar to identify relevant studies. The review included randomized controlled trials (RCTs) that compared at least two surgical techniques for hemorrhoidectomy in adult patients and reported on outcomes such as pain, recovery time, or complications. A total of 11 RCTs met the eligibility criteria for the final analysis. Results: The analysis revealed that modern techniques—specifically energy-based devices (e.g., Ligasure, harmonic scalpel) and stapled hemorrhoidopexy—consistently resulted in significantly lower postoperative pain scores compared to traditional excisional methods. These benefits were accompanied by reduced needs for analgesia, shorter hospital stays, and a faster return to normal activities. Furthermore, energy devices were associated with shorter operative times and a significantly lower incidence of specific complications, such as postoperative bleeding. Conclusion: Modern surgical techniques offer a substantially improved postoperative experience for patients undergoing hemorrhoidectomy. The reduction in pain, faster recovery, and lower rates of specific complications support the adoption of energy-based and stapled techniques as a new standard of care. While overall safety profiles are comparable to traditional methods, these advanced procedures provide clear, clinically meaningful benefits. Further research with long-term follow-up is recommended to assess recurrence rates and cost-effectiveness.

Background and objectiveAppendicitis is a common cause of acute abdominal pain and a frequent indication for emergency abdominal surgery. Laparoscopic appendectomy has become the preferred surgical treatment due to its many advantages over open appendectomy, including reduced morbidity, shorter hospital stay, and faster recovery. A critical step in laparoscopic appendectomy is the secure closure of the appendix stump to prevent postoperative complications. While laparoscopic appendectomy is widely practiced, there is no consensus on the optimal method for appendix stump closure. This prospective study aimed to compare the harmonic scalpel (HS) with suture ligation (SL) for appendix base closure in terms of operative time, surgical site infection (SSI), postoperative pain, postoperative ileus, and hospital stay.MethodsThis prospective randomized controlled trial was conducted at the Department of General Surgery, GSVM Medical College, Kanpur, involving 60 patients with appendicitis undergoing laparoscopic appendectomy. The data entry was performed using Microsoft Excel. The final statistical analysis was carried out using SPSS Statistics version 25.0 (IBM Corp., Armonk, NY). Continuous variables were presented as mean ± standard deviation (SD) or median with interquartile range (IQR), depending on data distribution. Categorical variables were expressed as frequencies and percentages. A p-value <0.05 was considered statistically significant.ResultsA total of 60 patients were randomized into two groups (30 each): HS and SL. The most affected age group was 18-42 years, with a male-to-female ratio of 1.2:1. The mean operative time was significantly shorter in the HS group (28.4 ± 6.2 minutes) compared to the SL group (43.3 ± 7.1 minutes, p<0.05). Postoperative pain scores were lower in the HS group at six, 24, and 48 hours (p<0.05). SSI (6.6% vs. 13.3%), postoperative ileus (6.6% vs. 13.3%), and readmission rates (3.3% vs. 10%) were all lower in the HS group. Hospital stay was also reduced (2.8 ± 1.2 vs. 3.5 ± 1.4 days, p<0.05), and patients returned to normal activities earlier.ConclusionsThis study demonstrates HS is a safe and effective alternative to suture ligation, offering improved surgical outcomes and faster recovery for appendiceal stump closure during laparoscopic appendectomy. HS significantly reduces operative time, postoperative pain, complication rates, hospital stay, and readmissions, while enhancing recovery and overall patient outcomes.

Subcutaneous Onlay Laparoscopic Approach for small ventral hernias associated with divarication of rectus abdominis muscle

Dear Editor, The introduction of laparoscopy to the surgical art is not new. Over the past few decades, operative laparoscopy has experienced remarkable advancements, enabling numerous complex procedures to be performed through this minimally invasive approach. Following its initial challenges, laparoscopic surgery has matured, evolving into a phase of gradual refinement, making it challenging to predict its future trajectory and long-term outcomes. However, in a resource limited country like Pakistan, the full implementation and acceptance of this new surgical technique comparable to the conventional Open approach is still questionable, pertaining to different causes like general population public awareness and economic constraints. The provision of laparoscope by government in our institution at MTI Gomal Medical College has revolutionized the standard of care but it has some shortcomings too, in the form of structured training programmes for the surgical staff, inconsistencies in instrument standardisation, affordability and public acceptability. Different surgical procedures are being performed at our institution, Cholecystectomy being the most common. Laparoscopic cholecystectomy as gold standard offers better outcomes than open cholecystectomy, with less pain, shorter hospital stays, and quicker recovery, but requires advanced infrastructure and costly equipment. In a few cases of laparoscopy cholecystectomy performed at our setup, the surgical team faced the problem of post-operative complications, including infection and bile leakage. During laparoscopic cholecystectomy, metallic clips are typically used to ligate the cystic duct and artery, However, complications such asclip slippage, a foreign body reaction that and, in rare cases, hypersensitivity reactions1, the clips becoming a nidus for infection, and a remote possibility of clip erosion in surrounding structures if dislodged. Vessel sealing technologies, such as LigaSure and Harmonic scalpel, offer promising alternatives for cystic artery control and haemostasis, yet their high cost poses a significant barrier in low-resource setting. Additionally, the use of these energy devices is questionable for the control of extra-hepatic biliary channels. The alternative to these metal clips is absorbable suturing material such as Vicry l. Different studies have looked into the safety and feasibility of cystic duct control with suture ligation during laparoscopic cholecystectomy2-4. A study by Akhtar et al. concluded that biliary leakage occurs more frequently with clipped laparoscopic cholecystectomy for cholecystitis, supporting the adoption of clip-less technique in select patients to minimize complications and optimize patient outcomes5. ---Continue

Aim: To compare the intraoperative parameters and postoperative complications of flap raising with harmonic scalpel and electrocautery. Methods: A prospective randomised controlled trial done on 60 cases of breast carcinoma undergoing Modified radical mastectomy in Guru Nanak Dev hospital, Amritsar. 30 patients were operated using harmonic scalpel (Group A) and thirty patients were operated using electrocautery (Group B). Results: The mean intraoperative blood loss was significantly lower with harmonic scalpel (107.33+38.44ml v/s 241.00+75.76 ml, p value=0.00). There was no statistically significant difference between mean operative time between group A and B (76.73+10.13 min v/s 85.26+13.95 min, p=0.067). The mean drain volume was significantly less in harmonic scalpel group (376.66+158.85 ml v/s 528.33 + 234.68 ml, p=0.038) and mean day of drain removal (4.60+1.6 days v/s 6.53+1.8 days, p=0.005). There is no significant difference of incidence of seroma formation, flap necrosis, postoperative complications like wound dehiscence, wound infection and wound disruption and postoperative pain on VAS between two groups. The stitch removal day and final healing time is also almost same in both groups.

The harmonic scalpel (HS) and cavitron ultrasonic surgical aspirator (CUSA) are two common techniques for liver parenchymal transection (LPT). The second International Consensus Conference on laparoscopic liver resection (LLR) recommended the utilization of the HS for superficial layer LPT and the CUSA for deep layer LPT. Some centers currently employ the HS for deep-layer LPT. However, the potential effect of HS during deep layer transection in LLR remains unclear. The study aims to investigate the feasibility, safety, and efficiency of HS in LLR compared with CUSA. This is a study protocol for a randomized controlled trial (RCT). This RCT will be carried out at West China Hospital of Sichuan University from January 2024 to December 2025. Consecutive patients who underwent LLRs during this period will be recruited based on the specified inclusion and exclusion criteria. The participants will be randomly allocated to the HS group or the CUSA group. The primary outcome is intraoperative blood loss. Secondary outcomes include parenchymal transection velocity, operative time, conversion rate, postoperative hospital stays, hospital cost, morbidity, and mortality. Subgroup analysis will be performed according to liver cirrhosis. The corresponding statistical approach will be used for statistical analysis. The trial has been reviewed and approved by the Biomedical Ethics Review Committee of West China Hospital, Sichuan University, on January 19, 2024. This study will clarify the feasibility, safety, and efficiency of HS for LPT in LLRs. The results will provide more reliable clinical evidence for the selection of LPT devices in LLRs. The study protocol was registered in the Chinese Clinical Trial Registry (http://www.chictr.org.cn) on April 26, 2024, ChiCTR2400083493. The protocol version is V2.0.

Abstract. Introduction. Hereditary microspherocytosis (HMS) is a disorder characterized by defects in erythrocyte membranes, leading to their destruction in the spleen and disturbances in bilirubin metabolism. Among the most common complications of HMS is cholelithiasis. Splenectomy (SE) and laparoscopic cholecystectomy (LC) are effective treatment methods. The aim of the study is to evaluate the effectiveness of simultaneous surgeries (SS) using laparoscopic techniques in the combination of cholelithiasis and hereditary microspherocytosis (HMS). Materials and methods: In 13 patients with hereditary microspherocytosis (HMS), cholelithiasis was diagnosed, and these patients underwent simultaneous splenectomy (SE) and cholecystectomy (CE). All patients underwent comprehensive laboratory and instrumental diagnostics. In 5 patients, laparoscopic access was used for simultaneous surgery (LCE + LSE), while in 8 patients, a hybrid procedure was performed (LCE + laparotomic SE). Video laparoscopic surgical interventions were performed using the Karl Storz system (Germany). Intraoperatively, the “Harmonic Scalpel Ultracision” ultrasonic device (Ethicon, USA) was used as a dissector and coagulator, while Endo-GIA staplers (Autosuture, USA) were used for vascular pedicle management of the spleen. Results and discussion: In 8 patients, simultaneous surgery (SS) was performed using a hybrid technique that combined laparoscopic and laparotomic access. In 5 patients, SS was performed entirely using the laparoscopic method. Spleen mobilization with an ultrasonic scalpel was carried out quickly, as the division of ligaments and adhesions was not accompanied by bleeding. Proper preoperative preparation, the correct choice of surgical access and technique for combined SE and CE using an ultrasonic scalpel and stapling device, along with adequate postoperative therapy, help prevent technical errors, postoperative complications, and significantly improve outcomes in patients with HMS. The simultaneous performance of SE and CE does not increase the severity of the surgical procedure or the postoperative course. Conclusions: 1. The use of an extended diagnostic program for hereditary microspherocytosis (HMS) complicated by cholelithiasis allows for a well-founded determination of surgical tactics and the selection of the optimal surgical approach. The use of an ultrasonic scalpel and linear stapler during splenectomy in patients with HMS significantly facilitates spleen mobilization, reduces intraoperative blood loss, and minimizes the risk of intraand postoperative complications. The application of laparoscopic and hybrid techniques for simultaneous surgery (SS) in HMS complicated by cholelithiasis helps avoid the need for repeat surgical intervention, ensures high treatment efficacy, and provides significant medical and social benefits compared to performing two separate procedures.

Background: Thyroid surgery is one of most commonly employed procedures by the surgeons. Evolution of the technique was based on different techniques employed during the dissection of the thyroid tissue, control of bleeding to ensure hemostasis and nerve monitoring with the aim to decrease the complications during the intraoperative and the post operative period. Objective was to compare total thyroidectomy with FOCUS Harmonic scalpel with conventional vascular ligature technique in patients undergoing total thyroidectomy. It was a randomized controlled Trial conducted at the CMH Bahawalpur from 1st July to 31st Dec 2022 (6 Months). Methods: A total number of 78 patients who were planned for total thyroidectomy were included in the trial. Employing a non-probability consecutive sampling technique via lottery method 39 patients were assigned to either of the 02 groups, i.e., Group A (harmonic scalpel technique) and Group B (conventional vascular ligature technique). Recorded variables included mean operative time, intraoperative and postoperative blood loss. Demographic characteristics and ASA grade were recorded for each patient. Results: Mean age of the patients in Group A was 44.05±6.37 years while 44.79±7.62 years in Group B. Male to female ratio was 1:2 among the total participants with 26 (33.3%) males and 52 (66.7%) females however male participants in both groups were 11 (28.2%) versus 15 (38.5%) and females were 28 (71.8%) versus 24 (61.5%) respectively. Harmonic scalpel technique showed significant results in terms of mean operative time, intraoperative and post operative blood loss as compared to conventional vessel ligature technique with a p&lt;0.05. Conclusion: In terms of mean operative time, intraoperative and postoperative blood loss Harmonic scalpel technique is superior to conventional vascular ligature technique for total thyroidectomy.

Introduction: Breast cancer is a major public health problem in the world. Amongthe multidisciplinary approach of surgery, chemotherapy, radiotherapy andhormonal therapy, Modified Radical Mastectomy (MRM) is the most commonsurgery performed to treat breast cancer wherein use of thermal energy hasbeen associated with seroma formation, increased blood loss, wound infection,flap necrosis, hematoma, and prolonged axillary drainage. Harmonic scalpelis an emerging alternative where high frequency mechanical vibrations allowcutting and coagulation at the same time causing little thermal injury. In thisstudy, we compared the outcome between use of harmonic scalpel andelectrocautery in modified radical mastectomy. Methods: A prospective comparative study was conducted at a tertiary carecentre of Nepal from November 2018 to October 2019.A total of 30 patientswere randomized into harmonic scalpel and electrocautery group andcompared in terms of seroma formation, operative time, amount of blood loss,total drain volume, total duration of drain, and post-operative pain. Results: The patients in harmonic scalpel group had significantly less amountof seroma formation (13.3% vs 46%, p=0.046), intraoperative blood loss (150 vs200 ml, p=0.026), total drain volume (483.33 ± 107.718 vs 636.33 ± 239.620ml,p=0.032),total duration of drain requirement(8.73 ±1.907 vs12.13± 4.121, p= 0.007)and post-operative pain (p=0.002). However, operative time (p=0.20) andsurgical site infection (p=0.14) was not significant. Conclusions: Harmonic scalpel has better surgical outcome than electrocauteryin terms of intraoperative blood loss, total drainage volume, total durationof drain and postoperative pain without change in operative time. We thusrecommend preferential use of harmonic scalpel in MRM.

To describe the surgical technique, indications and complications associated with laparoscopic cholecystectomy (LC) in cats and to report the clinical outcomes. Retrospective study. A total of 22 client-owned cats. Medical records of cats that underwent LC between 2018 and 2024 were reviewed. Data collected included signalment, clinical signs, laparoscopic approach, concomitant surgical procedures, number of portals, instrument type used for ligation of the cystic duct, operating time, complications and clinical outcome. A 3- or 4-port technique was used in 16 and six cats, respectively. The cystic duct ligation was performed with Hemoclips (n = 14) or with Hem-o-lok (n = 8). The devices used for gallbladder dissection included harmonic scalpel (n = 5), Ligasure (n = 14) and monopolar j-hook (n = 3). The procedure was successfully performed without conversion to open laparotomy in all cases. The median operating time was 41 min. Postoperative complications occurred in three cats: one was treated medically, one spontaneously resolved without intervention and the third cat died 3 days after surgery due to extra hepatic biliary duct obstruction (EHBDO). The final follow-up time for the 21 cases that survived to discharge ranged between 48 and 321 days (median 159 days). LC was performed successfully using a 3- or 4-port technique in all cases. LC was associated with a low complication rate and a good clinical outcome. LC may be considered as an alternative to open cholecystectomy in cats with gallbladder disease that do not present with biochemical or imaging evidence of EHBDO or biliary tract rupture.

Background and Objectives: With the increasing life expectancy, the frequency of total thyroidectomies in elderly patients has risen, raising concerns regarding hemorrhage and recurrent laryngeal nerve palsy compared to the general population. Therefore, considering the frequent alteration of the coagulation status in such patients, innovative methods able to reach an accurate hemostasis appear highly desirable. This retrospective multicentric study aimed to compare the postoperative outcomes of patients treated with conventional hemostasis with patients treated with the Harmonic Scalpel (HS) and gelatin-thrombin matrix (Floseal). Materials and Methods: Patients undergoing total thyroidectomy were retrospectively enrolled and categorized into two groups: Group A patients underwent surgery with the Harmonic Scalpel and Floseal, while Group B underwent traditional hemostasis surgery with ligations and monopolar electrocautery. The primary endpoint was the drain output after 24 and 48 h and the presence of significant blood loss. Secondary endpoints included the presence of seroma, wound infection, hematoma, laryngeal nerve palsy, surgery duration, and onset of post-surgical hypocalcemia. Results: From January 2014 to January 2024, 870 individuals participated in the study. Group A (gelatin-thrombin and HS) comprised 502 patients, while Group B (Standard Hemostasis-control group) comprised 368 patients. The 24 h drain output was 52 ± 25 mL in Group A vs. 113 ± 27 mL in Group B, p = 0.003, while the 48 h drain output was 95 ± 29 mL in Group A and 113 ± 27 mL in Group B (p = 0.002). Significant blood loss occurred in eight patients (2.2%) of Group B vs. three cases (0.6%) in Group A (p = 0.039). Also, neck hematoma (p = 0.012), seroma (p = 0.005), and reoperation (p = 0.052) values were significantly lower in Group A. Conclusions: Surgery aided with HS, and gelatin-thrombin was associated with lower major and minor complications compared to the conventional approach, guarantying reduced operative time, ensuring hemostasis, and preserving parathyroid glands, even in elderly patients.

Background: Seroma is a common complication of breast cancer surgery. Seroma can also interfere with healing, increase morbidity, and lead to delayed adjuvant treatment. Objective: To compare seroma formation, seroma volume, total drain volume, and drain duration between the combined flap fixation and Harmonic scalpel technique with the Harmonic scalpel technique alone after a mastectomy and axillary lymph node dissection in a breast cancer patient. Materials and Methods: A randomized control trial was conducted between October 2021 and October 2023 at the Department of Surgery, Surin Hospital. Sixty-four consecutive patients underwent mastectomies and axillary lymph node dissection. The patients were randomly assigned to Group 1 as Flap fixation and Harmonic scalpel technique with 32 patients and Group 2 as Harmonic scalpel technique alone, also with 32 patients. Results: Ninety-two patients underwent mastectomies and 28 patients were excluded. Sixty-four patients underwent mastectomies and axillary lymph node dissection. The mean age was 55.08±12.58 years. Twenty-two patients (34.4%) developed clinical seroma, with five patients (15.6%, 95% CI 5.3 to 32.8) being in the combined flap fixation and Harmonic scalpel technique group and seventeen patients (53.1%, 95% CI 34.7 to 70.9) being in the Harmonic scalpel technique alone group. The combined flap fixation and Harmonic scalpel technique could reduce seroma formation and volume significantly compared to the Harmonic scalpel technique alone (p=0.002 and 0.007, respectively). No statistical significance was found in the total drain volume (p=0.742) and drain duration (p=0.457) between the two groups. The combined flap fixation and Harmonic scalpel technique was significantly correlated with longer operative time (p=0.004). Conclusion: A randomized control trial showed that the combined flap fixation and Harmonic scalpel technique could reduce seroma formation and seroma volume after a mastectomy and axillary lymph node dissection in a breast cancer patient.

Background and Aim Thyroidectomy techniques have remained largely unchanged for decades. Recently, there have been accounts of the employing of the harmonic scalpel (HS) throughout Thyroidectomy. Here we aimed to compare total thyroidectomy employing HS and standard suture ligation technique. Patients and methods This prospective investigation was conducted in the period from October 2020 to September 2021 on patients admitted with thyroid disease, either benign or malignant in the Department of Surgery, Al-Azhar University Hospital, Damietta. The data collection method includes volume of drained fluid, operative time, intraoperative blood loss, and postsurgical complications such as seroma postoperative bleeding or wound infection. Results The HS group (A) experienced a notably reduced intraoperative duration compared with the traditional hemostasis group (B). Additionally, the total volume of fluid drainage and intraoperative blood loss were considerably less in the HS group (A) than in the traditional hemostasis group (B). Bleeding after surgery was noted in three (5%) patients from the conventional hemostatic group (B), compared with two (1.67%) patients in the HS group (A). Only two patients in the conventional thyroidectomy group developed a postoperative seroma. Conclusions HS in total thyroidectomy significantly reduces postoperative complications, drainage volume, intraoperative blood loss, and intraoperative time.

Impact of parenchymal transection techniques on intraoperative blood loss during liver resection in a porcine model of elevated central venous pressure: A comparative study.

Biliary complications of robotic harmonic scalpel &amp; Maryland bipolar liver transection technique

Outcome of Laparoscopic Appendectomy with Clipping versus Harmonic Scalpel for Closure of the Appendicular Stump: A Comparative Clinical Study