title: The Harmonic Scalpel versus Conventional Hemostasis for Neck Dissection: A Meta-Analysis of the Randomized Controlled Trials.
abstract: OBJECTIVE
  Neck dissection is the most definitive and effective treatment for head and neck cancer. This systematic review aims to compare the efficacy and surgical outcomes of neck dissection between the harmonic scalpel and conventional surgical techniques and conduct a quantitative meta-analysis of the randomized trials.
  
  
  METHODS
  Randomized controlled trials (RCTs) were identified from the major electronic databases (MEDLINE, EMBASE and Cochrane Library) using the keywords ''harmonic scalpel'' and ''neck dissection,'' and a quantitative meta-analysis was conducted. The operative time and intraoperative bleeding were the primary outcome measures, and other parameters assessed included the drainage fluid volume and length of hospital stay.
  
  
  RESULTS
  Seven trials that met the inclusion criteria included 406 neck dissection cases (201 in the harmonic scalpel group). Compared with conventional surgical techniques, the HS group had an operative time that was significantly reduced by 29.3 minutes [mean difference: -29.29; 95% CI = (-44.26, -14.32); P=0.0001], a reduction in intraoperative bleeding by 141.1 milliliters [mean difference: -141.13; 95% CI = (-314.99, 32.73); P=0.11], and a reduction in drainage fluid volume by 64.9 milliliters [mean difference: -64.86; 95% CI = (-110.40, -19.32); P=0.005] , but it is not significant after removal of studies driving heterogeneity. There was no significant difference in the length of the hospital stay [mean difference: -0.21; 95% CI = (-0.48, 0.07); P=0.14].
  
  
  CONCLUSIONS
  This systematic review showed that using the harmonic scalpel for neck dissection significantly reduces the operative time and drainage fluid volume and that it is not associated with an increased length of hospital stay or perioperative complications. Therefore, the harmonic scalpel method is safe and effective for neck dissection. However, the statistical heterogeneity was high. Further studies are required to substantiate our findings.
authors.affiliation: Department of Oral and Maxillofacial & Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Zhen-Hu
authors.initials: ZH
authors.lastname: Ren
authors.affiliation: Department of Respiratory Medicine, Shanghai chest hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Jian-Lin
authors.initials: JL
authors.lastname: Xu
authors.affiliation: Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Wuhan University, Wuhan, China.
authors.forename: Teng-Fei
authors.initials: TF
authors.lastname: Fan
authors.affiliation: Department of Oral and Maxillofacial & Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Tong
authors.initials: T
authors.lastname: Ji
authors.affiliation: Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, Changsha, China.
authors.forename: Han-Jiang
authors.initials: HJ
authors.lastname: Wu
authors.affiliation: Department of Oral and Maxillofacial & Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Chen-Ping
authors.initials: CP
authors.lastname: Zhang
mesh_terms: D016063:Blood Loss, Surgical; D004322:Drainage; D006488:Hemostasis, Surgical; D006801:Humans; D007902:Length of Stay; D037981:Neck Dissection; D061646:Operative Time; D017594:Publication Bias; D016032:Randomized Controlled Trials as Topic; D013525:Surgical Instruments