Advantages of a new technique of neck dissection using an ultrasonic scalpel

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SUMMARY

The aim of the study was to see whether a new technique of a neck dissection applying an ultrasonic activated (harmonic) scalpel would improve patient recovery.

Material and methods

A prospective, non-randomized study was undertaken on 40 supraomohyoid neck dissections performed using a harmonic scalpel (20 pts) or electrocoagulation (20 pts). The evaluation included: operation time, intraoperative blood loss, postoperative seroma formation and pattern of wound healing.

Results

The operative time (mean±SD) using a harmonic scalpel was significantly shorter (52±10 min vs. 86±22 min; p⩽0.001) and the blood loss was less (13±7 ml vs. 85±58 ml; p⩽0.001), neck drainage on the first and second postoperative days were significantly smaller after using the ultrasonic scalpel (30±26 ml; 44±23 ml vs. 77±65 ml; 118±66 ml, p⩽0.001). Wound healing complications amounted to only 5% (20% in the control group).

Conclusion

The use of the harmonic scalpel during neck dissection led to diminished bleeding, shorter operative time, lesser seroma formation and better wound healing in the postoperative period.

Introduction

Excision of cervical lymph nodes in oral cancer was first described by George Crile (1906) as a radical neck dissection. This approach has undergone various modifications but still suffers from a relatively high morbidity. A total of 40–60% of patients present with surgical complications of differing magnitude. Healing disturbances occurred in 61% (Magrin and Kowalski, 2000) of which the most frequent were wound infection and dehiscence. In the series of Baffi et al. (1980), 30% of the patients developed severe postoperative oedema and 14% had a wound infection; the total complication rate was 54%. Cabra Duenas et al. (1994) report on 43% complications in 195 functional neck dissections. These were wound infection (23%), serohaematoma (20%), wound dehiscence (17%), haemorrhage (5.6%) or chylous fistula (2%).

To improve the patient's recovery, the application of modern technology was studied in order to diminish the negative aspects of this surgery. In the ultrasonic-activated (harmonic) scalpel, high-frequency mechanical energy is applied to cut and coagulate using a temperature not exceeding 80 °C without any electrical current (Mantke et al., 2003). This allows tissue dissection and vessel occlusion at the same time with a reduced thermal damage to the surrounding tissue when compared with traditional diathermy (Kinoshita et al., 1999; Emam and Cuschieri, 2003). Effectiveness and a high level of safety have justified the use of this device in dissection of anatomical structures and vessel ligation in laparoscopic surgery (Ortega et al., 2004). Only a few reports have been published about the use of the harmonic scalpel in open surgery (Meurisse et al., 2000; Metternich et al., 2001, Metternich et al., 2003a, Metternich et al., 2003b; Mantke et al., 2003; Ortega et al., 2004) and until now there have been no studies about its value in neck dissection.

The aim of this investigation was to establish whether the ultrasonic activated scalpel could improve the outcome of patients with oral cancer following neck dissection.

Section snippets

Material and methods

A prospective, non-randomized study was undertaken on patients undergoing surgery for oral squamous cell carcinoma with an Ultracision® Harmonic Scalpel (Ethicon Endo-Surgery, Germany, Fig. 1) or with the use of scissors and eletrocoagulation. Twenty supraomohyoid neck dissections were performed in both groups by the same team. The characteristics of the patients were balanced and encompassed location of the tumour, TNM staging, age, sex, weight and volume of the dissected tissue as well as the

Results

There was no statistically significant difference between the study and the control group regarding patient demographics, diagnosis, weight and volume of the removed specimens as well as the number of the excised lymphnodes. The operation time (mean±SD) using harmonic scalpel was significantly shorter (52±10 min) than when applying the traditional method (86±22 min; p<0.01; Fig. 2). The blood loss during the ultracision procedure (13±7 ml) was considerably less than in the control group (85±58 ml; p

Discussion

Neck dissection for oral cancer is a well-established method for loco-regional control of the lymphatic spread of the disease. An introduction of new operative techniques based on modern technology improves several negative consequences of the surgery. The mechanism of the harmonic scalpel is based on transforming electrical energy into mechanical movement of 55.5 kHz frequency with a help of a piezo-crystalline device (Lee and Park, 1999; Haegner et al., 2002). The vibrating tip causes a

Conclusion

The use of the harmonic scalpel during neck dissection has numerous advantages: diminished bleeding, shortened operation time, lesser seroma formation and better wound healing when compared with the standard technique using surgical diathermy. This method is promising and worth further investigation in maxillofacial surgery.

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