title: Efficiency and outcomes of harmonic device in transanal endoscopic microsurgery compared with monopolar scalpel.
abstract: BACKGROUND
  An important fact when facing new technologies is their cost for the Health Publishes. The purpose of this paper is to compare the costs of performing TEM with harmonic scalpel and classic monopolar scalpel and to analyze complications.
  
  
  METHODS
  Operation time, blood loss, and hospital stay were recorded to determine the cost of the TEM procedure. We also recorded early and late complications. Patients were divided in two groups: harmonic scalpel group (UC) and monopolar scalpel group (MS).
  
  
  RESULTS
  TEM for curative intention was used in 330 rectal tumors from January 1997 to January 2010. A total of 229 patients met the criteria for this study: UC group (n = 87) and MS group (n = 142). Patients from the UC group developed fewer complications (16%) than patients from the MS group (23%). The difference of mean stay between groups was 1.5 days (95% confidence interval, 0.7; 2.2 days; P < 0.001) in favor of the UC group.
  
  
  CONCLUSIONS
  Harmonic scalpel provides a safer, easier, and more precise surgical section through clean, bloodless, and better visualized operative field. The additional cost of UC was compensated with the decrease in the health resources (mainly hospital stay).
authors.affiliation: Coloproctology Unit, Department of Surgery, Hospital Clinico Universitario, Zaragoza, Spain. josegraciasolanas@hotmail.com
authors.forename: J A
authors.initials: JA
authors.lastname: Gracia
authors.forename: J M
authors.initials: JM
authors.lastname: Ramirez
authors.forename: D
authors.initials: D
authors.lastname: Callejo
authors.forename: M
authors.initials: M
authors.lastname: Elia
authors.forename: S
authors.initials: S
authors.lastname: Maeso
authors.forename: V
authors.initials: V
authors.lastname: Aguilella
authors.forename: M
authors.initials: M
authors.lastname: Martinez
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008866:Microsurgery / Q000295:instrumentation*; D008875:Middle Aged; D011183:Postoperative Complications; D012004:Rectal Neoplasms / Q000601:surgery*; D013525:Surgical Instruments; D013997:Time Factors; D016896:Treatment Outcome; D014464:Ultrasonic Therapy / Q000295:instrumentation*