New trends in head and neck surgery: a prospective evaluation of the Harmonic Scalpel.
BACKGROUND
The use of ultrasonic technology to cut and coagulate tissues with minimal tissue damage has been investigated in general surgery and gynecology. The purpose of this study was to verify the efficacy and applicability of the Harmonic Scalpel in head and neck surgery.


METHODS
A non-randomized study was undertaken on 40 pharyngolaryngectomies, 40 total laryngectomies, 40 radical neck dissections, and 40 superficial parotidectomies performed using the Harmonic Scalpel (80 patients) or "cold knife" dissection (80 patients). The evaluation included operation time, intraoperative blood loss, quantity of neck drainage on the first and second postoperative days, postoperative seroma formation, pattern of wound healing, days of hospitalization, and subjective assessment of postoperative pain.


RESULTS
In patients treated with the Harmonic Scalpel, the mean operation time was significantly (p<0.05) shorter (119.1+/-1.35 vs. 156.9+/-1.51), intraoperative blood loss (121.5+/-1.28 vs. 257.5+/-2.32) and the quantity of neck drainage on the first (47+/-0.87 vs. 89+/-1.28) and second (38.7+/-0.86 vs. 75.5+/-1.34) postoperative days were significantly less, and the days of hospitalization (6.67+/-0.48 vs. 8.8+/-0.58) and the pain scores (3.24+/-0.63 vs. 5.91+/-0.83) were significantly lower than in the "cold knife" group. No postoperative complications were noted in the Harmonic Scalpel group.


CONCLUSIONS
The use of the Harmonic Scalpel in head and neck surgery is safe and confers some advantages over conventional methods of head and neck dissection.
Salami
Angelo
A
Department of Otorhinolanyngology, University of Genoa, Italy.
Dellepiane
Massimo
M
Bavazzano
Maurizio
M
Crippa
Barbara
B
Mora
Francesco
F
Mora
Renzo
R
D016063:Blood Loss, Surgical / Q000517:prevention & control*; D004867:Equipment Design; D005260:Female; D006801:Humans; D007825:Laryngectomy / Q000295:instrumentation; D008297:Male; D037981:Neck Dissection / Q000295:instrumentation* / Q000379:methods; D010306:Parotid Gland / Q000601:surgery; D019106:Postoperative Hemorrhage / Q000517:prevention & control; D011446:Prospective Studies; D013525:Surgical Instruments; D013514:Surgical Procedures, Operative; D013997:Time Factors; D014465:Ultrasonics