Harmonic scalpel compared with conventional open (Milligan-Morgan) method in surgical management of symptomatic haemorrhoids

Background: There have been many attempts to find less painful surgical methods for treating haemorrhoids. Harmonic scalpel is a device that simultaneously cuts and coagulates soft tissues through ultrasonic vibrations. The aim of this study was to compare the results of Harmonic scalpel hemorrhoidectomy with conventional Milligan Morgan hemorrhoidectomy for the treatment of grade III and IV hemorrhoids.Methods: Patients with grade III or IV hemorrhoids, operated between January 2016 and December 2016, using the harmonic scalpel (n=30) or the conventional open technique (n=30) were studied. Both the groups were compared with respect to Operative time, Blood loss during surgery, early postoperative complications, postoperative pain measured on a visual analog scale (VAS), hospital stay, and return to normal work.Results: Harmonic scalpel and conventional open haemorrhoidectomy patients differ significantly in terms of VAS score of postoperative pain, blood loss during surgery, early post-operative complications, return to normal work. However, there is no significant difference in terms of duration of surgery and hospital stay in both the groups.Conclusions: Harmonic scalpel haemorrhoidectomy has been found advantageous method when assessing the amount of bleeding intraoperatively, post-operative pain, early postoperative complications, and Return to normal work. Hence Harmonic scalpel haemorrhoidectomy can be adapted as a safe and effective alternate method for treating symptomatic haemorrhoids.

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Harmonic Scalpel versus Conventional Haemostasis in Neck Dissection: A Prospective Randomized Study

International Journal of Surgical Oncology ◽

10.1155/2013/369345 ◽

2013 ◽

Vol 2013 ◽

pp. 1-8 ◽

Cited By ~ 2

Author(s):

Emanuele Ferri ◽

Enrico Armato ◽

Giacomo Spinato ◽

Marcello Lunghi ◽

Giancarlo Tirelli ◽

...

Keyword(s):

Postoperative Pain ◽

Postoperative Complications ◽

Blood Loss ◽

Hospital Stay ◽

Neck Dissection ◽

Operative Time ◽

Harmonic Scalpel ◽

Intraoperative Blood Loss ◽

Bipolar Diathermy ◽

Classic Technique

Purpose.The aim of this prospective randomized trial was to compare operative factors, postoperative outcomes, and surgical complications of neck dissection (ND) when using the harmonic scalpel (HS) versus conventional haemostasis (CH) (classic technique of tying and knots, resorbable ligature, and bipolar diathermy).Materials and methods.Sixty-one patients who underwent ND with primary head and neck cancer (HNSCC) resection were enrolled in this study and were randomized into two homogeneous groups: CH (conventional haemostasis with classic technique of tying and knots, resorbable ligature, and bipolar diathermy) and HS (haemostasis with harmonic scalpel). Outcomes of the study included operative time, intraoperative blood loss, drainage volume, postoperative pain, hospital stay, and incidence of intraoperative and postoperative complications.Results.The use of the HS reduced significantly the operating time, the intraoperative blood loss, the postoperative pain, and the volume of drainage. No significant difference was observed in mean hospital stay and perioperative, and postoperative complications.Conclusion.The HS is a reliable and safe tool for reducing intraoperative blood loss, operative time, volume of drainage and postoperative pain in patients undergoing ND for HNSCC. Multicenter randomized studies need to be done to confirm the advantages of this technique and to evaluate the cost-benefit ratio.

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Comparative Analysis for the Treatment of Hemorrhoids Using Harmonic Scalpel versus Conventional Hemorrhoidectomy: A Single-Center Experience

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2020/v32i2330729 ◽

2020 ◽

pp. 164-170

Author(s):

Fatma Al- Thoubaity

Keyword(s):

Wound Healing ◽

Patient Satisfaction ◽

Postoperative Pain ◽

Pain Relief ◽

Postoperative Complications ◽

Blood Loss ◽

Patient Group ◽

Harmonic Scalpel ◽

Conventional Hemorrhoidectomy ◽

Grade Iii

Background: Hemorrhoidectomy is one of the most effective treatments for Grade III/IV hemorrhoids. This study was aimed to compare the outcomes and postoperative complications arising from the harmonic scalpel hemorrhoidectomy with conventional hemorrhoidectomy. Methods: In this retrospective study, 1120 patients were operated on for symptomatic Grade III/IV hemorrhoids during April 2004-April 2020. In the conventional hemorrhoidectomy patient group, the operation was performed by Ferguson closed method using monopolar electrocautery, while the other patient group was operated using a harmonic scalpel. Patient demographic data and common patient complaints were recorded. Operation duration and blood loss during the procedure were noted. Regular follow up of the patients was done for 4 weeks, and postoperative pain relief was recorded using the Visual Analog Scale. Finally, patient satisfaction and complete wound healing were analyzed along with postoperative complications like incontinence, secondary hemorrhage, recurrence, and anal stenosis. Results: The patient demographic characteristics and preoperative complaints were similar for both groups. Harmonic scalpel procedure resulted in shorter operation time and less blood loss. Postoperative pain relief was substantially better in the patient group who underwent harmonic scalpel hemorrhoidectomy. Harmonic hemorrhoidectomy procedure also resulted in higher patient satisfaction and wound healing. Minimal postoperative complications were observed for both groups. Conclusion: Harmonic scalpel hemorrhoidectomy is a safe and effective procedure that achieves simultaneous tissue and vessel sealing. It reduces the duration of the operation, blood loss, postoperative pain, and complications compared to a conventional hemorrhoidectomy procedure.

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Is Obesity a Risk Factor for Spinal Surgeries? A Retrospective Study in a Specialized Orthopedic Spine Center

Journal of Research in Orthopedic Science ◽

10.32598/jrosj.8.1.759.1 ◽

2021 ◽

Vol 8 (1) ◽

pp. 37-42

Author(s):

Hasan Ghandhari ◽

◽

Ebrahim Ameri ◽

Mohsen Motalebi ◽

Mohamad-Mahdi Azizi ◽

...

Keyword(s):

Retrospective Study ◽

Postoperative Complications ◽

Blood Loss ◽

Hospital Stay ◽

Length Of Hospital Stay ◽

Obese Group ◽

Obese Patients ◽

Number Of Patients ◽

Significant Difference ◽

Duration Of Surgery

Background: Various studies have shown the effects of morbid obesity on the adverse consequences of various surgeries, especially postoperative infections. However, some studies have shown that the complications of spinal surgery in obese and non-obese patients are not significantly different. Objectives: This study investigated and compared the duration of surgery, length of hospital stay, and complications after common spinal surgeries by orthopedic spine fellowship in obese and non-obese patients in a specialized spine center in Iran. Methods: All patients who underwent decompression with or without lumbar fusion were included in this retrospective study. These patients were classified into two groups: non-obese (BMI <30 kg/m2) and obese (BMI ≥30 kg/m2). The data related to type and levels of surgery, 30-day hospital complications, length of hospital stay, rate of postoperative wound infection, blood loss, and need for transfusion were all extracted and compared between the two groups. Results: A total of 148 patients (74%) were in the non-obese group and 52 patients (26%) in the obese group. The number of patients that need packed cells was significantly higher in the obese group (51.8% vs 32.6%) (P=0.01). Otherwise, there were not a significant difference between type of treatment (fusion or only decompression) (P=0.78), interbody fusion (P=0.26), osteotomy (P=0.56), duration of surgery (P=0.25), length of hospital stay (P=0.72), mean amount of blood loss (P=0.09), and postoperative complications (P=0.68) between the two groups. Conclusion: Our results suggest that duration of surgery, length of hospital stay, and postoperative complications are not associated with the BMI of the patients.

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Comparative study of management of grade III hemorrhoids by Harmonic Scalpel technique versus conventional surgical technique (Milligan Morgan method)

International Surgery Journal ◽

10.18203/2349-2902.isj20173877 ◽

2017 ◽

Vol 4 (9) ◽

pp. 3007

Author(s):

Amrithraj Thiyagarajan ◽

Shubhi Bhatnagar

Keyword(s):

Fecal Incontinence ◽

Blood Loss ◽

Harmonic Scalpel ◽

Postoperative Outcome ◽

Late Complications ◽

Analgesic Requirement ◽

Significant Difference ◽

Hospital Stays ◽

Grade Iii

Background: The study aimed to compare the management of Grade III hemorrhoids by conventional Milligan Morgan versus Harmonic scalpel hemorrhoidectomy with respect to the intraoperative time, intra operative blood loss, length of hospital stays, postoperative outcome based on immediate and late complications and activity resumption, recurrence and cost.Methods: In this prospective study, a total of 60 patients, 30 patients undergoing Harmonic Scalpel hemorrhoidectomy and 30 patients undergoing Milligan Morgan hemorrhoidectomy, were studied. Operated patients were monitored for bleeding, pain, retention of urine, fecal incontinence ambulatory time and recurrence.Results: Symptoms such as pain during defecation, bleeding PR were significantly reduced at follow up in patients undergoing Harmonic scalpel hemorrhoidectomy over Milligan Morgan technique. Fecal incontinence was present in 8 cases following Milligan Morgan method over 3 months follow up. Recurrence was highest in (26.08%) in Milligan Morgan group while lowest in (4.34%) in Harmonic Scalpel group. No of days absent from work is more Milligan Morgan group and significantly less in Harmonic Scalpel group.Conclusions: This study showed significant difference in operative time, blood loss during surgery and pain score on postoperative days 15, 1 month, 3 months and 6 months and postoperative analgesic requirement for Harmonic scalpel assisted hemorrhoidectomy as compared to conventional Milligan Morgan, which were statistically significant. Harmonic scalpel hemorrhoidectomy is a newer, safer, more effective, faster and bloodless operative technique with minimal tissue damage and further larger sample studies and required to establish its complete efficacy and benefit over other modalities of hemorrhoidectomy.

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Bipolar Radiofrequency Dissection Tonsillectomy: A Prospective Randomized Trial

Otolaryngology ◽

10.1016/j.otohns.2005.07.037 ◽

2005 ◽

Vol 133 (6) ◽

pp. 961-965 ◽

Cited By ~ 17

Author(s):

Sameh M. Ragab

Keyword(s):

Postoperative Pain ◽

Postoperative Complications ◽

Blood Loss ◽

Operative Time ◽

Operating Time ◽

Controlled Study ◽

Operative Blood Loss ◽

Bipolar Radiofrequency ◽

Significant Difference ◽

Cold Dissection

OBJECTIVES: To conduct a prospective randomized controlled study presenting and comparing bipolar radiofrequency dissection tonsillectomy (BRDT) to cold dissection tonsillectomy (CDT) regarding intra-operative blood loss, operative time, postoperative pain, and postoperative complications including hemorrhage. MATERIALS AND METHODS: From January 2004 to March 2005, 200 children planned to undergo tonsillectomy were included in this study. Children were prospectively randomized into two equal groups: bipolar radiofrequency dissection tonsillectomy and cold dissection tonsillectomy. The operative time and intraoperative blood loss were recorded. Children were asked to record their pain on a standardized visual analog scale on days 1, 4, 7, and 14. All children were reviewed on the 4th, 7th, and 14th day after surgery. Postoperative complications were recorded and dealt with. RESULTS: There was a shorter operative time (mean 8.5 minutes, P < 0.001) in the radiofrequency group. BRDT showed a decrease of 7 minutes in the mean when compared to the CDT group. The amount of blood lost during BRDT was minimal (mean 13 cc), with a mean difference of 69 cc when compared to CDT ( P < 0.001). There was no statistical significant difference in pain score between the two groups except in the first postoperative day where the BRDT demonstrated a statistically significant lower parameters ( P < 0.05). No evidence for statistically significant difference between the two groups regarding postoperative complications. CONCLUSION: BRDT is a new, easy, and safe technique that offers a complete eradication of the tonsillar disease, short operating time, minimal intra-operative blood loss, and a suitable cost with no additional increase in postoperative pain and hemorrhage when compared to the conventional CDT. Our experience promotes BRDT as the preferred method of tonsillectomy. EBM RATING: A

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Focus Harmonic Scalpel Compared to Conventional Haemostasis in Open Total Thyroidectomy: A Prospective Randomized Trial

International Journal of Otolaryngology ◽

10.1155/2011/357195 ◽

2011 ◽

Vol 2011 ◽

pp. 1-7 ◽

Cited By ~ 29

Author(s):

Emanuele Ferri ◽

Enrico Armato ◽

Giacomo Spinato ◽

Roberto Spinato

Keyword(s):

Postoperative Pain ◽

Hospital Stay ◽

Randomized Trial ◽

Total Thyroidectomy ◽

Operative Time ◽

Harmonic Scalpel ◽

Thyroid Volume ◽

Prospective Randomized Trial ◽

Drainage Volume ◽

Significant Difference

The aim of this prospective randomized trial was to compare operative factors, postoperative outcomes and surgical complications of open total thyroidectomy when using the Harmonic Scalpel (HS) versus Conventional Haemostasis (CH).Methods. 100 consecutive patients underwent open total thyroidectomy were randomized into two groups: group CH (Conventional Haemostasis) and group HS (Harmonic Scalpel). We recorded the following: age, sex, pathology, thyroid volume, haemostatic technique, operative time, drainage volume, thyroid weight, postoperative pain, postoperative complications, and hospital stay. The results were analyzed using the Student’sttest and test.Results. No significant difference was found between the two groups concerning mean thyroid weight and mean hospital stay. The mean operative time was significantly shorter in the HS group. The total drainage fluid volume was lower in HS group. Two (4%) transient recurrent laryngeal nerve palsies were observed in CH group and no one (0%) in the HS group. Postoperative transient hypocalcemia occurred more frequently in the CH group. HS group experienced significantly less postoperative pain at 24 and 48 hours.Conclusions. In patients undergoing thyroidectomy, HS is a reliable and safe tool. Comparing with CH techniques, its use reduces operative times, postoperative pain, drainage volume and transient hypocalcemia.

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Primerjava laparoskopske apendektomije pri enostavnem in zapletenem vnetju slepiča

Slovenian Medical Journal ◽

10.6016/zdravvestn.1752 ◽

2017 ◽

Vol 86 ◽

Author(s):

Matjaž Križaj ◽

Erik Štrumbelj ◽

Stanislav Mahne

Keyword(s):

Postoperative Complications ◽

Acute Appendicitis ◽

Hospital Stay ◽

Laparoscopic Appendectomy ◽

Conversion Rate ◽

Complicated Appendicitis ◽

Early Postoperative Complications ◽

Stump Closure ◽

Significant Difference ◽

Diagnostic Modalities

Background: Laparoscopic appendectomy has been gaining ground as a gold standard for the treatment of acute appendicitis. For complex inﬂammation there is no common opinion. A higher conversion rate, longer operative time, higher incidence of abscess formation and longer hospitalization are being reported. The aim of our study was to compare the diagnostic modalities, treatment and postoperative complications in uncomplicated and complicated appendicitis.Methods: In our institution laparoscopic appendectomy is the method of choice for the treatment of every type of appendicitis. In our retrospective analysis, all patients with acute appendicitis operated on in the years 2013 and 2014 were included. Among 273 patients, 19 were excluded due to primary open procedure and one who underwent revision surgery for other disease and had appendectomy performed. In 253 patients we observed the proportion of the postoperative complications in uncomplicated and complicated cases with respect to patients’ age, period of the year, duration of hospital stay, diagnostic modalities, drainage of the abdominal cavity, conversion rate and stump closure.Results: The analysis showed a steep increase of complicated appendicitis in elderly population, but there were no significant diﬀerences regarding period of the year (χ2 test, p = 0.158). The hospital stay was longer in complicated cases (5.94 days v. 3.049 days). When a preoperative CT scan was performed, cases were more often complicated (CT 0.654, no CT 0.229; χ2 test, p < 0.001), as was the proportion of drain insertions during surgery (0.5490 v. 0.065; χ2 test, p < 0.001). The proportion of clips for the stump closure was higher in the uncomplicated group (0.717 v. 0.521; χ2 test, p = 0.005). The rate of early postoperative complications and conversion rate revealed no significant diﬀerence.Conclusions: We have found out there is a diﬀerence in diagnostic modalities and treatment options in uncomplicated and complicated appendicitis, but no significant diﬀerence in the conversion rate and early postoperative complications. Our analysis suggests that laparoscopic appendectomy is a safe method in all types of appendicitis.

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A Comparative Analysis of Laparoscopic Appendectomy in Relation to the Open Appendectomy in Children / Uporedna Analiza Laparoskopske Apendektomije U Odnosu Na Otvorenu Apendektomiju Kod Dece

Serbian Journal of Experimental and Clinical Research ◽

10.1515/sjecr-2016-0013 ◽

2016 ◽

Vol 17 (1) ◽

pp. 49-53

Author(s):

Irena Nikolic Mickovic ◽

Zoran Golubovic ◽

Sasa Mickovic ◽

Dejana Vukovic ◽

Sanja Trajkovic ◽

...

Keyword(s):

Postoperative Complications ◽

Hospital Stay ◽

Laparoscopic Appendectomy ◽

Medical Records ◽

Acute Inflammation ◽

Open Appendectomy ◽

Length Of Hospital Stay ◽

Surgical Methods ◽

Significant Difference ◽

Surgery Duration

Abstract Acute inflammation of the appendix in childhood usually requires an appendectomy. Surgical methods are open appendectomy (OA) and laparoscopic appendectomy (LA). Both have the same goal of removing the appendix. Data collected from the medical records of children who underwent hospitalization and operation for acute appendicitis have been retrospectively analysed and statistically processed. The patients underwent surgery in 2010 at University Children’s Hospital in Belgrade, and the methods that were used were open appendectomy (OA) and laparoscopic appendectomy (LA). The analysed data refer to gender, age, length of hospital stay, surgery duration, use of pain management therapy, and antibiotic therapy, complications during surgery, complications after surgery, re-hospitalizations, and reoperations. A total of 218 children underwent an appendectomy operation, of which 158 (72.5%) underwent OA and 60 (27.5%) underwent LA. The average age of patients who had OA was 11.44 years, and 10.87 years for those who underwent LA. The surgery duration was significantly longer for LA (45.3 vs. 42.1 minutes, p = 0.003). The total number of postoperative complications was lower in LA (1 vs. 12), but there was no statistically significant difference. The number of hospital stay days was significantly lower in LA (3.48 vs. 5.45 days), with a high statistical difference, p = 0.00. The advantages of LA compared with OA are shorter hospital stay, lower total number of intraoperative and postoperative complications, and fewer reoperations. The advantage of OA compared with LA is shorter surgery duration.

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Harmonic scalpel thyroidectomy versus conventional haemostasis thyroidectomy

International Surgery Journal ◽

10.18203/2349-2902.isj20210363 ◽

2021 ◽

Vol 8 (2) ◽

pp. 559

Author(s):

Ajaz U. Haq ◽

Tariq Mahmood ◽

Sheetal Kumari ◽

Aneesa Afzal

Keyword(s):

Postoperative Pain ◽

Hospital Stay ◽

Operative Time ◽

Harmonic Scalpel ◽

Jammu And Kashmir ◽

Drainage Volume ◽

Informed Consent Form ◽

Significant Difference ◽

The Mean ◽

Operative Drainage

Background: As there is paucity of data on harmonic scalpel thyroidectomy from Jammu and Kashmir belt. So, we conducted this study to bridge this gap and also to create awareness about the use of harmonic scalpel. Thyroidectomy has become one of the most common and frequent surgery. Hemostasis in thyroid surgery is of utmost importance for a successful surgery. Our aim was to compare operative factors, postoperative outcomes of thyroidectomy using the Harmonic Scalpel (HS) and Conventional Haemostasis (CH).Methods: In this randomized control trial study, 100 patients who underwent thyroidectomy were enrolled and randomly divided in two groups- HS group and CH group. The inclusion criteria were age>18years, acceptance to participate in the study (signed informed consent form) and scheduled total thyroidectomy. The groups were compared with regards to age, gender, operative time, post-operative drainage volume, postoperative pain, and hospital stay.Results: The mean age in years was 39.8 years for HS group and 43.8 years for CH group with female preponderance. There was a significant difference with regards to operative time, post-operative drainage volume, postoperative pain, and hospital stay (p<0.001). Harmonic Scalpel shortens the operative time. And there was less post-operative drainage volume and postoperative pain in HS group. Hospital stay was also less as compared to CH group.Conclusions: HS is superior then CH thyroidectomy and is considered as a safe and better tool in thyroidectomy.

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Harmonic scalpel versus conventional haemorrhoidectomy for grade III and IV haemorrhoids: a randomized controlled trial

International Surgery Journal ◽

10.18203/2349-2902.isj20171610 ◽

2017 ◽

Vol 4 (5) ◽

pp. 1627

Author(s):

Atul Philipose ◽

Murtaza Akhtar ◽

Divish Saxena ◽

Siddharth Keswani

Keyword(s):

Randomized Controlled Trial ◽

Postoperative Pain ◽

Blood Loss ◽

Urinary Retention ◽

Harmonic Scalpel ◽

Controlled Trial ◽

Anal Stenosis ◽

Randomized Controlled ◽

Conventional Haemorrhoidectomy ◽

Grade Iii

Background: Haemorrhoidal disease is one of the most frequently encountered anorectal condition in the clinical practice of a surgeon. Haemorrhoidectomy is the treatment of choice for grade III and IV haemorrhoids but is associated with significant postoperative pain and complications. Harmonic dissection causes less lateral tissue injury and thus less intra-operative bleeding and post-operative complications. The present study compares Harmonic Haemorrhoidectomy with conventional Haemorrhoidectomy.Methods: In a randomized controlled trial, patients with grade III and IV haemorrhoids satisfying inclusion and exclusion criteria were allocated to Harmonic scalpel haemorrhoidectomy or conventional Milligan Morgan open haemorrhoidectomy by block randomisation of 4. The outcome factors were intra operative blood loss, postoperative pain on VAS scale, urinary retention and anal stenosis after one month of follow up.Results: Total of 40 cases were enrolled. Of them, 22 were allocated to Harmonic haemorrhoidectomy, the rest 18 patients underwent conventional haemorrhoidectomy. The mean age of patients was 47.03 years with a Male to Female ratio of 1.35:1. Intraoperative blood loss measured by number of soaked gauze pieces and pain score measured on visual analogue scale at 12, 24 and 48hours was seen to be statistically significant (p<0.001) lesser in patients who underwent Harmonic scalpel haemorrhoidectomy. There was no statistically significant difference in operative time urinary retention or anal stenosis.Conclusions: Harmonic scalpel haemorrhoidectomy appears to be a better procedure for symptomatic grade III and grade IV haemorrhoids with ease of operating due to less bleeding, good postoperative recovery and patient acceptance.

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