title: Harmonic scalpel versus electrocautery in breast reduction surgery: a randomized controlled trial.
abstract: BACKGROUND
  The authors hypothesized that the Harmonic Scalpel (Ethicon Endo-Surgery, Cincinnati, Ohio) might outperform electrocautery in bilateral breast reduction surgery, possibly resulting in (1) shorter operative times, (2) lower postoperative fluid drainage rates, and (3) reduced postoperative pain scores.
  
  
  METHODS
  Thirty-one patients were evaluated in a matched-pair design, with random (blinded) assignment of one side to the Harmonic Scalpel, with the other side defaulting to electrocautery. Main outcome measures were: (1) resection/hemostasis time, (2) drainage volume, and (3) postoperative pain. The authors also compared the learning curves, operative time versus specimen weights, complications, and costs for the devices.
  
  
  RESULTS
  There was a statistically significant (but not clinically significant) difference between the median times for the Harmonic Scalpel (33 minutes) and electrocautery (31 minutes) (p=0.02). There was no statistical difference in drainage scores, and pain scores were equivalent. The analysis of specimen weight versus resection/hemostasis time showed no correlation. There were more complications on the breasts reduced with the Harmonic device, but due to the small sample size, the complication results were not statistically significant. Start-up costs for the devices were comparable, but the per-procedure cost for the Harmonic device was considerably higher.
  
  
  CONCLUSIONS
  The Harmonic Scalpel is roughly equivalent to electrocautery in breast reduction surgery in terms of resection/hemostasis time, serous drainage, and postoperative pain. Though the Harmonic device may be excellent for other surgical procedures, its high cost suggests that surgeons and institutions can confidently forgo its use in breast reduction surgery.
  
  
  METHODS
  Therapeutic, II.
authors.affiliation: Lebanon, N.H. From the Division of Plastic and Reconstructive Surgery and the Leadership Preventive Medicine Residency Program, Dartmouth-Hitchcock Medical Center.
authors.forename: Todd E
authors.initials: TE
authors.lastname: Burdette
authors.forename: Carolyn L
authors.initials: CL
authors.lastname: Kerrigan
authors.forename: Karen A
authors.initials: KA
authors.lastname: Homa
mesh_terms: D000328:Adult; D004564:Electrocoagulation / Q000009:adverse effects / Q000379:methods*; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000295:instrumentation / Q000379:methods*; D008875:Middle Aged; D011183:Postoperative Complications / Q000503:physiopathology; D018570:Risk Assessment; D016037:Single-Blind Method; D013525:Surgical Instruments; D013997:Time Factors; D016896:Treatment Outcome; D014464:Ultrasonic Therapy / Q000009:adverse effects / Q000295:instrumentation*; D055815:Young Adult