Is harmonic scalpel an effective tool for oesophagectomy?
BACKGROUND
Use of electrocautery in oesophagectomy is standard; however, the introduction of the harmonic scalpel (HS) and its use has changed the methodology of oesophagectomy in recent years. We have assessed the efficiency of HS in oesophageal cancer surgery. The parameters studied were blood loss, transfusion rates, and postoperative complications.


METHODS
Our cohort included 142 patients who underwent elective oesophagectomy from January 1999 to December 2004. The control group was the patients undergoing electrocautery oesophagectomy (n=98) between 1999 and 2002. Furthermore, 44 patients who were operated with the HS were included in the study group.


RESULTS
The numbers of units transfused were significantly less in HS group (median 0) in comparison with controls (median 2), p=0.003. Median blood loss in HS and the controls was 500 and 700 ml respectively (p=0.123). Mortality in HS group was 2.27%compared to 3.06% in controls (p=0.14). The complication (principally respiratory) rate was only 13.6% of patients in HS group compared to 17.3% in the controls.


CONCLUSIONS
Our study shows that HS reduces transfusion rates and postoperative complications, highlighting it as a safe and effective alternative to traditional electrocautery.
Waraich
Naseem
N
Oesophago-Gastric Centre, Derby Hospitals NHS Foundation Trust, Derby, UK. naseem.waraich@nottingham.ac.uk
Ahmed
Javed
J
Rashid
Farhan
F
Mulvey
David
D
Leeder
Paul
P
Iftikhar
Syed Y
SY