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Abstract

Aim: To compare the use of the Harmonic scalpel with traditional clamp and knot tying in open thoracic surgery.Study Design: Retrospective case-controlled studyPlace and duration of study: Cardiothoracic Surgery Unit, Post Graduate MedicalInstitute, Lady Reading Hospital, Peshawar, from June 2011 to December 2011.Patients: One hundred and fifty two consecutive patients undergoing open thoracic surgery by one surgeon.Interventions: Seventy-six patients underwent open thoracic surgery with theconventional clamp-and-tie technique (oesophagectomy, n=51; upper lobectomy, n=20; excision of retro sternal goiter, n= 5) and 76 with the harmonic scalpel (oesophagectomy, n=51; upper lobectomy, n=20; excision of retro sternal goiter, n= 5).Main Outcome Measures: Operative time and blood loss using a 2-tailed t test, _2 test, and Wilcoxon rank sum test.Results: The 2 groups were similar regarding age and sex. Mean ± SD operative time was shorter in the harmonic scalpel group compared with the conventional technique group for oesophagectomy (89±20 minutes vs. 115±25 minutes; P_.01), upper lobectomy (50±21 minutes vs. 80±28 minutes; P_.01) and excision of retrosternal goiter (54± 16 minutes vs. 88± 16 minutes P_.01) procedures. Mean ± SD blood loss was minimal in the harmonic scalpel group compared with the conventional technique group for oesophagectomy (250 ± 58mls vs. 480 ± 65mls; P_.01), upper lobectomy (280±21 ml vs. 488±28mls; P_.01) and excision of retrosternal goiter (154 ± 16mls vs. 318± 26mls; P_.01) procedures.Conclusions: The use of the harmonic scalpel is safe, and it shortens the operative time by almost 30 minutes and blood loss by almost 200 ml compared with the conventional technique for open thoracic surgical procedures.