Scalpel Group Research Articles

Evaluation of patient perception and intraoperative bleeding in labial frenectomy: A comparision of diode laser and conventional scalpel techniques

: High frenal attachments are abnormalities corrected by surgical procedure called frenectomies. The scalpel technique is associated with pain, bleeding and postoperative discomfort. To overcome these shortcomings, in the recent times, diode lasers are gaining popularity due to less bleeding, pain during the procedure, healing outcome, and need for analgesics: To compare the bleeding during the procedure and postoperative pain in patients requiring labial frenectomy using conventional scalpel and diode laser techniques. Twenty patients with high labial frenum attachment requiring frenectomy were included in this study. Patients were randomly divided into Group A: scalpel group and Group B: diode laser group. Pain assessment using VAS, severity of intraoperative bleeding and number of analgesics used were recorded: The analysis showed that VAS score for pain was significantly lower in the laser group as compared to the scalpel group Bleeding was mild in laser group, where as in scalpel group showed moderate or severe bleeding scores Post operative use of analgesics was more in scalpel group than laser group Laser was found to be an effective alternate to scalpel in performing frenectomy procedures, more importantly it showed less bleeding, less pain perception and more patient acceptance during the procedure.

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.

Histological assessment of a novel de-epithelialization method for connective tissue grafts harvested from the palate. An experimental study in cadavers

ObjectivesThis study aims to compare the histological outcomes of three distinct de-epithelialization methods used in (connective tissue grafts) CTG harvested from the palate.Materials and methodsAn experimental study using nine cadaver head specimens was carried out to compare 3 different de-epithelialization techniques for CTG. Eighteen samples were randomly allocated to three study groups: bone scraper, diamond bur and extraoral removal with a scalpel. The main outcome variable was the graft surface percentage without epithelium remains. Additionally, the time employed, and the graft thickness were also measured.ResultsSixteen CTGs were analyzed. The extraoral scalpel group presented a total surface area with no epithelium of 58.84% (22.68) and a mean de-epithelialization time of 3.7 min; the intraoral diamond bur group had 88.24% (41.3) of the surface with no epithelium and took 1.455 min, and the intraoral bone scraper showed 97.98% (5.99) of surface without epithelium and a mean time of 0.815 min (P < 0.05). Histological analysis showed significant differences between the bone scraper and the extraoral group (P = 0.009).ConclusionThe de-epithelialization technique with a bone scraper seems to be the most effective and fastest de-epithelialization technique for CTG. These findings need to be confirmed in future clinical studies with larger samples.Clinical relevanceThe use of bone scrapers, could be a simple, effective and fast technique to de-epithelialize connective tissue grafts harvested from the palatal area for both novice and experienced surgeons.

Comparison of the effect of ultrasounic-harmonic scalpel and electrocautery in the treatment of axillary lymph nodes during radical surgery for breast cancer

ObjectiveTo compare the efficacy of ultrasounic-harmonic scalpel and electrocautery in the treatment of axillary lymph nodes during radical surgery for breast cancer.MethodsA prospective study was conducted in the Department of Breast Surgery, Zhongda Hospital Affiliated to Southeast University. A total of 128 patients with pathologically confirmed breast cancer who were treated by the same surgeon from July 2023 to November 2023 were included in the analysis. All breast operations were performed using electrocautery, and surgical instruments for axillary lymph nodes were divided into ultrasounic-harmonic scalpel group and electrocautery group using a random number table. According to the extent of lymph node surgery, it was divided into four groups: sentinel lymph node biopsy, lymph node at station I, lymph node at station I and II, and lymph node dissection at station I, II and III. Under the premise of controlling variables such as BMI, age and neoadjuvant chemotherapy, the effects of ultrasounic-harmonic scalpel and electrocautery in axillary surgery were compared.ResultsCompared with the electrosurgical group, there were no significant differences in lymph node operation time, intraoperative blood loss, postoperative axillary drainage volume, axillary drainage tube indwelling time, postoperative pain score on the day after surgery, and the incidence of postoperative complications (p>0.05).ConclusionThere is no significant difference between ultrasounic-harmonic scalpel and electrocautery in axillary lymph node treatment for breast cancer patients, which can provide a basis for the selection of surgical energy instruments.

Comparative Efficacy of Ceramic Burs and Scalpels in Gingivectomy Procedures for Orthodontic Patients: A Case Series

Background: Orthodontic treatment often leads to gingival hyperplasia, which may complicate oral hygiene and necessitate surgical interventions such as gingivectomy. This study compared the efficacy of ceramic burs versus scalpels in gingivectomy procedures for orthodontic patients, focusing on periodontal outcomes and pain. Methods: This case series describes six orthodontic patients with gingival hyperplasia. The patients were between 15-25 years and were non-smokers. They underwent gingivectomy using two methods: ceramic burs (NTI® Soft Tissue Trimmers) and traditional scalpels. Preoperative oral hygiene instructions were given, and intraoral photographs were obtained. Clinical measurements included the plaque index (PI), gingival index (GI), and bleeding index (BI). Bleeding, pain (using a visual analog scale), and periodontal indices were assessed at several time points postoperatively. Results: Both groups showed significant improvements in gingival hyperplasia, PI, and mean GI. However, the ceramic bur group experienced lower postoperative pain compared to the scalpel group. One patient in the scalpel group required analgesics for pain management. The results highlighted the effective management of gingival hyperplasia with both methods but with a potential advantage in pain management for the ceramic bur group. Conclusion: This study indicated that both ceramic burs and scalpels are effective for gingivectomy in orthodontic patients. Ceramic burs might offer a less painful alternative, although both methods effectively manage gingival hyperplasia. Further studies with a larger sample size and longer follow-ups are required to confirm the present findings and potentially recommend ceramic burs as a preferred method for gingivectomy.

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.

Post-Operational Photodynamic Therapy of the Tumor Bed: Comparative Analysis for Cold Knife and Laser Scalpel Resection.

In this paper, we report on a study regarding the efficiency of the post-operational phototherapy of the tumor bed after resection with both a cold knife and a laser scalpel in laboratory mice with CT-26 tumors. Post-operational processing included photodynamic therapy (PDT) with a topically applied chlorin-based photosensitizer (PS), performed at wavelengths of 405 or 660 nm, with a total dose of 150 J/cm2. The selected design of the tumor model yielded zero recurrence in the laser scalpel group and 92% recurrence in the cold knife group without post-processing, confirming the efficiency of the laser scalpel in oncology against the cold knife. The application of PDT after the cold knife resection decreased the recurrence rate to 70% and 42% for the 405 nm and 660 nm procedures, respectively. On the other hand, the application of PDT after the laser scalpel resection induced recurrence rates of 18% and 30%, respectively, for the considered PDT performance wavelengths. The control of the penetration of PS into the tumor bed by fluorescence confocal microscopy indicated the deeper penetration of PS in the case of the cold knife, which presumably provided deeper PDT action, while the low-dose light exposure of deeper tissues without PS, presumably, stimulated tumor recurrence, which was also confirmed by the differences in the recurrence rate in the 405 and 660 nm groups. Irradiation-only light exposures, in all cases, demonstrated higher recurrence rates compared to the corresponding PDT cases. Thus, the PDT processing of the tumor bed after resection could only be recommended for the cold knife treatment and not for the laser scalpel resection, where it could induce tumor recurrence.

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.&#x0D; 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.&#x0D; 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 &lt; 0.001). Also, no recurrent nerve damage was detected in the study.&#x0D; 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.

Diathermy versus Scalpel Skin Incision for Open Inguinal Hernia Surgery: An Interventional Study

Introduction: Inguinal hernia is one of the most encountered surgical-related problems worldwide. For years, there has been debate among surgeons about which type of skin incision to use: cutting with electrocautery or the traditional method of a surgical scalpel. Aim: To compare the skin incisions made with electrocautery versus traditional scalpel incisions in terms of incision time, blood loss, postoperative pain, and scar evaluation. Materials and Methods: A hospital-based prospective interventional study was conducted at the Department of General Surgery, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India, from November 2019 to September 2021. Written informed consent was obtained from 130 consecutive cases scheduled for open inguinal hernia surgery. Patients were alternately assigned to undergo incision with electrocautery (group A) or a conventional steel scalpel (group B), with each group comprising 65 patients. Bilateral hernia cases were treated as separate entities. Data analysis was performed using Microsoft Excel and Statistical Package for Social Sciences (SPSS) software version 24.0, employing the Student’s t-test and Chi-square test. A p-value of &lt;0.05 was considered statistically significant. Results: The age distribution in group A was 49.69±15.74 years and in Group B was 52.81±14.25 years. The time taken for incision in the electrocautery group was much shorter at 12.57±11.55 seconds than in the scalpel group at 20.63±2.99 seconds, with a p-value of &lt;0.001. The average amount of blood loss in group A was 1.02±0.35 mL and in group B was 2.03±0.32 mL, with a significant p-value of &lt;0.001. The postoperative pain, calculated by the Visual Analogue Scale (VAS), showed a significant difference in the early postoperative period at 6 hours after surgery in Group A at 6.58±0.9 compared to group B at 7.05±1, with a p-value of 0.005. However, no significant difference was noted between the two groups at 12, 24, and 48 hours after surgery. There was no significant difference in scar evaluation between group A and group B at 12 weeks, with a p-value of 0.673 for the patient score and 0.189 for the observer score. Conclusion: Electrocautery can be recommended for hernia skin incision due to its advantage of shorter incision time, minimal blood loss, and less early postoperative pain.

Comparison of Electrocautery and Scalpel Incision in Midline Abdominal Surgery

Background: With the advancement of surgical techniques, the comparison of electrocautery and scalpel incisions in midline abdominal surgeries has become an essential area of study. Traditional scalpel incisions have been known for their precision but carry risks of excessive blood loss and sharp injuries. Electrocautery, offering a potentially safer and more efficient alternative, has been gaining attention in surgical practices. Objective: The primary objective of this study was to compare the effectiveness, safety, and outcomes of electrocautery versus scalpel incisions in midline abdominal surgeries, with a focus on incision time, blood loss, wound infection, and postoperative pain. Methods: A randomized controlled trial was conducted at the Military Hospital, Rawalpindi, over 12 months from June 2021 to June 2022. A total of 150 patients, split evenly into electrocautery and scalpel groups, were evaluated. Patients aged 20-75 years, undergoing midline abdominal surgery, were included. The main parameters measured were incision time, blood loss, wound infection, and postoperative pain. Data were analyzed using SPSS version 25.0, employing independent samples t-tests and chi-square tests. Results: The electrocautery group exhibited a significantly shorter incision time (13.73 ± 2.45 seconds) compared to the scalpel group (18.67 ± 3.02 seconds, p &lt; 0.001). Blood loss was also lower in the electrocautery group (11.47 ± 2.49 ml) than in the scalpel group (27.27 ± 4.13 ml, p &lt; 0.001). Wound infection rates were 6.7% for electrocautery and 13.3% for scalpel, though this was not statistically significant (p = 0.174). Remarkably, 100% of the electrocautery group reported postoperative pain, in contrast to none in the scalpel group (p = 0.000). Conclusion: The study concluded that electrocautery is more effective than scalpel incision in terms of incision time and blood loss, making it a preferable method for midline abdominal surgeries. However, the higher incidence of postoperative pain in the electrocautery group warrants further investigation.

Assessment of clinical outcomes and patient response to gingival depigmentation using a scalpel, ceramic bur, and diode laser 980 nm

ObjectiveThis research compares the clinical outcomes of gingival depigmentation procedures with conventional scalpel, ceramic trimmer bur, and diode laser techniques.Materials and methodsTwenty-four individuals with physiologic gingival hyperpigmentation received random allocation to one of three treatment groups: scalpel, ceramic bur, or diode laser. Pain score, operation time, bleeding index, degree of epithelialization, wound healing, Dummett-Gupta Oral Pigmentation Index (DOPI), and Takashi Index score changes were all investigated at different time points.ResultsAt 12-h follow-up, significant variations in pain scores were seen between the laser and scalpel groups (p = 0.003) but not between the laser and ceramic bur groups. The diode laser group completed the procedure significantly quicker than the scalpel and ceramic bur groups (p = 0.004 and p = 0.001, respectively). The ceramic trimmer bur and diode laser groups showed significantly less bleeding tendency than the scalpel group. Wound healing and the degree of epithelialization were similar in all groups. DOPI and Takashi indices significantly decreased compared to baseline in all groups, with no significant difference recorded between all groups.ConclusionWhile diode lasers are a safe and effective treatment option for gingival hyperpigmentation, providing optimal aesthetics with reduced discomfort to patients, a ceramic trimmer bur can also be used as a simple and affordable alternative to a laser in gingival depigmentation procedures.Clinical relevanceGingival hyperpigmentation is a major aesthetic issue for many individuals. Laser and ceramic trimmer bur treatments produce equivalent aesthetic outcomes for gingival hyperpigmentation.

Comparing the intraoperative and postoperative complications of the scalpel and electrocautery techniques for severing the inner layers of the lumbar disc during discectomy surgery.

Due to the sensitivity of the surgical site and a higher probability of injury, the use of a scalpel and electrocautery to create an incision in the spine is discussed. In this study, we will compare the intraoperative and postoperative complications of the scalpel and electrocautery techniques for severing the inner layers of the lumbar disc during discectomy surgery. This study was conducted in Iran as a randomized controlled trial with double-blinding (1,401). Sixty candidates for spine surgery were randomly divided into two groups of 30 using electrocautery (A) and a scalpel (B) based on available sampling. The VAS scale was used to assess postoperative pain. The duration of the incision and intraoperative blood loss were recorded. The infection and fluid secretions were determined using the Southampton scoring scale. Utilizing the Manchester scar scale, the wound healing status was evaluated. The SPSS version 16 software was used for data analysis (t-test, Mann-Whitney U, ANOVA). The electrocautery group had substantially lower bleeding, pain, and wound healing rates than the scalpel group (P > 0.05). However, the electrocautery group had significantly longer surgical times, more secretions, and a higher infection rate than the scalpel group (P > 0.05). In terms of demographic and clinical characteristics, there was no significant difference between the two groups (P < 0.05). Electrocautery reduces postoperative hemorrhage and, potentially, postoperative pain in patients. However, as the duration of surgery increases, so does the duration of anesthesia, and patient safety decreases. Additionally, the risk of infection increases in the electrocautery group compared to the scalpel group, and the rate of wound healing decreases. https://www.irct.ir/, identifier (IRCT20230222057496N1).

The Outcomes of Using Scalpel and Electrosurgery Methods for Anterior Abdominal Wall Incision During Cesarean Section

Background: There are different ways to make a surgical incision. The most widely used ones are the use of scalpel and electrosurgery. Each of these methods has advantages and disadvantages that affect its use. Objectives: This study aimed to compare scalpel and electrosurgery methods in cutting the anterior abdominal wall during Cesarean section. Methods: This double-blind clinical trial manner was conducted by permuted block randomization. The participants were placed in two groups. In the scalpel group, incisions were made with a scalpel, and in the electrosurgery group, incisions were made with an electrosurgical pencil. This clinical trial was conducted on 86 pregnant women who were candidates for Cesarean section with spinal anesthesia. The inclusion criteria were an age range of 18 - 45 years, gestational age of 37 - 41 weeks, Pfannenstiel skin incision, and willingness to participate. The exclusion criteria were emergency Cesarean section, vertical skin incisions, incomplete medical files, chronic skin diseases, allergy to antibiotics, consuming anticoagulants, cardiovascular and pulmonary problems, and underlying diseases. Results: There was no significant difference between the two groups in terms of intraoperative bleeding, newborn Apgar score, postoperative pain, and wound complications. However, the duration of surgery (P = 0.012), incision time (P = 0.049), and hemodynamic status showed a significant difference (P &lt; 0.05). Conclusions: The use of electrosurgery to make a surgical incision does not pose a risk to the patient if safety points are followed.

Clinical and histological comparison of healing by steel scalpel, diode laser, and radiofrequency in palatal wound: An animal study.

Wound healing following periodontal soft tissue procedures can differ owing to different techniques, the feasibility of which can be determined through detailed macroscopic and microscopic observations. This study aimed to clinically and histologically evaluate palatal wound healing in rats by secondary intention after excision using a steel scalpel, diode laser, and radiofrequency. An excision was made in the edentulous anterior maxilla of 42 4-month-old male Wistar rats weighing 289-428 g. Part of the connective tissue was left in the surgical area to observe the dynamics of secondary intention wound healing. Three experimental groups were established: the steel scalpel, an 810-nm diode laser at a power output of 1.5 W in continuous mode, and a monopolar radiofrequency in a fully rectified waveform at 15 W. Clinical and histological analyses were performed on days 2, 4, and 7. Hemostasis, changes in body weight, defect size, epithelial gap, and inflammatory infiltration were evaluated. The epithelial gap closed completely in all groups on day 7. Bleeding occurred significantly more in the scalpel group (P < 0.001). No significant changes were observed in body weight between the groups. Macroscopically, the mean wound area decreased over time in all groups. Wound healing was significantly slower in the laser group on day 2 and in the radiofrequency group on days 4 and 7 (P < 0.001). Microscopically, the laser created the cleanest wound area, with minimal inflammatory infiltration and no thermal injury. More damage occurred in the connective tissue of the radiofrequency group. Wound healing was observed on day 7 in all groups. Palatal wound healing with secondary intention yielded different outcomes in a rat model when different techniques were used. However, almost complete healing was observed in all wounds, which highlights the importance of the soft tissue left in the surgical area. Wound healing in periodontal soft tissue procedures is not compromised by different techniques, as long as the clinician has sufficient knowledge and experience.

Effect of making skin incision with electrocautery on positive Cutibacterium acnes culture rates in shoulder arthroplasty: a prospective randomized clinical trial

Cutibacterium acnes remains the most commonly detected organism in shoulder arthroplasty. C. acnes infection is thought to occur during shoulder arthroplasty through contamination of the surgical field with C. acnes from the incised dermis. The purpose of this study was to examine whether using electrocautery for making skin incisions would decrease C. acnes culture rates at the incised dermis compared to using scalpels during shoulder arthroplasty. Patients undergoing primary shoulder arthroplasty were randomized into 2 groups, Electrocautery vs. Scalpel incision group. All patients received a standard preoperative antiseptic preparation including chlorhexidine gluconate showers, intravenous antibiotic administration, and topical application of hydrogen peroxide, povidone iodine, isopropyl alcohol, and DuraPrep. Cultures were obtained from the incised dermal edge immediately after skin incision and later from surgeon's gloves and forceps immediately prior to humeral component implantation. The primary outcome was positive C. acnes culture rates compared between the groups. A total of 64 patients (32 in each group) were enrolled. There were 24 males in each group. Regarding dermis cultures, 10 patients (31%) in the Scalpel group were positive with 8 of them positive for C. acnes, whereas no patients in the Electrocautery group were positive (p < 0.001). Regarding glove cultures, the Electrocautery group had 8 patients positive C. acnes, while the Scalpel group had 8 (p = 0.777). Regarding forceps cultures, the Electrocautery group had 4 patients positive for C. acnes, and the Scalpel group had 6 (p = 0.491). All positive cultures were exclusively from male patients. There were no wound complications or infection in the Electrocautery group while the Scalpel group had one acute postoperative infection. Making skin incisions using electrocautery resulted in zero C. acnes culture at the incised dermis, suggesting its potential effect against C. acnes. However, despite this initial antibacterial effect, C. acnes still appeared on surgeon's gloves and forceps during surgery of male patients. All positive cultures were from male patients, suggesting that the source of C. acnes was specifically related to the male body. While the study hypothesis was supported by the results, the present study also raises new questions and calls for further research.

Histological evaluation of mouse tongue incisions after Er:YAG laser surgery with different pulse energies versus after conventional scalpel surgery.

To identify the surgical instrument that allows for optimal healing of tongue incisions. An Er:YAG laser was compared with different pulse energies to a conventional scalpel for the incision of mouse tongue tissues. Mice were sacrificed through cervical dislocation at 24, 48, and 72 h postoperatively, followed by extraction of their tongues for incision experiments. The healing of the incisions and expression of inflammation- and pain-related factors in the tongues were compared between the surgical procedure groups. In laser-treated mice, tongue incisions healed the fastest when the laser output energy was 60 MJ per pulse. Macrophage chemotaxis toward the incisional area was triggered on the first postoperative day for the 60-MJ group, while the time for macrophage chemotaxis to the surgical area was later in the 80-MJ group. Tumor necrosis factor-alpha expression increased and then decreased in the 80-MJ group; however, it gradually decreased in the 60-MJ and conventional scalpel groups. Prostaglandin E2 expression increased and then decreased in the 80-MJ and conventional scalpel groups but gradually decreased in the 60-MJ group. The expression of transforming growth factor beta 1 gradually decreased in the 60-MJ and 80-MJ groups but gradually increased in the conventional scalpel group. Compared with surgical procedures using conventional scalpels, those using an Er:YAG laser with appropriate pulse energies can inhibit inflammation in the incisional area and promote incision healing. The use of an Er:YAG laser with appropriate pulse energies can alleviate intraoperative and postoperative pain in the incisional area.

A Comparative Study of Mucosal Wound Healing after Excision with a Scalpel, Diode Laser, or CO2 Laser.

Forty-five Sprague Dawley rats were used in this study. These rats were divided into two laser intervention groups (CO2, n = 15; diode, n = 15) and one control group with scalpel excision (n = 15). The effectiveness of therapy has been assessed based on the comparison of intraoperative, postoperative, and histological parameters on days 7, 21, and 35, and postoperative weight changes as pain indicator. Both laser groups demonstrated significantly (P < 0.05) less bleeding than did the control group during the intraoperative stage, whereas the CO2 laser showed more precise cutting compared with the diode laser (P < 0.05). The highest healing score was reported in the CO2 and scalpel groups on the first week of healing than in the diode group (P < 0.05). However, no significant difference was observed between the groups on days 21 and 35. Weight loss was significantly (P < 0.05) demonstrated in the diode group compared to the scalpel and CO2 groups till day 7. Both laser groups demonstrated delayed healing process compared with the scalpel. Nevertheless, the CO2 group followed the scalpel trends after day 7. Scalpel and CO2 laser yielded a superior clinical outcome compared with the diode excision of oral mucosa, whereby the CO2 has been proposed as the most effective laser type at the end of the first postoperative month.

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.

Mean Postoperative Pain in patients with Elective Midline Laparotomies Using Either Scalpel or Diathermy for Incision

Background: During a laparotomy, the midline incision is frequently made with an electrocautery or scalpel. According to studies, there is no difference between these procedures' rates of complications. Aim : To assess the average postoperative pain in patients who underwent elective midline laparotomies at the Hayatabad Medical Complex Peshawar using either a scalpel or diathermy for incision. Methodology: This was a randomized controlled trial, which included 60 laparotomies patients who were divided into two groups at random. One group of patients had diathermy, whilst the other group underwent scalpel incisions. On the second postoperative day, a follow-up was conducted. Results: In diathermy group we had 63.3% males and 36.7% females while in the scalpel group we had 17 males and 13 females. 40% patients in diathermy group were hypertensive, this ratio was 36.7% in the scalpel group, diabetic patients were 26.7% in diathermy group and 16.7% in scalpel group. Practical implication: Cutting by diathermy is simpler, quicker, and results in less blood loss. Furthermore using diathermy to make an incision is no more likely to result in complications than using a scalpel Conclusion: For an elective laparotomy, skin incision with diathermy provides superior postoperative pain management than a scalpel. Keywords: Diathermy, incision, Laparotomy, woundpain, scalpel

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.