New harmonic scalpel versus conventional hemostasis in right colon surgery: a prospective randomized controlled clinical trial.

Background: The Harmonic Scalpel (HS) is a device that uses vibrations to coagulate and cut tissues simultaneously. Its advantages are represented by minimal lateral thermal tissue damage, less smoke formation, no neuromuscular stimulation and no transmission of electricity to the patient.

Methods: A total of 211 consecutive patients (113 men, 98 women; mean age 64 years) undergoing hemicolectomy for cancer of the right colon were divided into two groups, namely those in whom the operation was performed using a new HS handpiece (NHS; 108 patients) and those assigned to conventional hemostasis (CH; 103 patients). The two surgical groups were compared regarding patients' age and sex, tumor size, location, histotype and local invasiveness assessed by American Joint Cancer Committee stage, operative time, fluid content in the suction balloon (drainage volume) during the first 1-3 days after surgery, hospital stay and complications.

Results: Ultrasonic energy delivered through an HS has been shown to be safe and to produce minimal damage to the surrounding tissues because of its minimal heat production. Electrical devices allow hemostatic control in vessels up to 3 mm in diameter, while HS can coagulate vessels up to 5 mm in diameter; thus, HS allows not only better control of bleeding but also of lymphorrhea. In fact, the amount of fluid collected in the drainage was significantly lower in the NHS group compared to the CH group. Protein depletion influences the patient's regenerative capacity and thus also the occurrence of complications and recovery time.

Conclusion: NHS is a useful device in colon surgery; it facilitates surgical maneuvers and reduces operative times and blood and lymphatic losses, allowing satisfactory maintenance of protein storage. This results in a lower incidence of complications and faster recovery by patients.