A Systematic Review and Meta-Analysis of Harmonic Scalpel Versus Conventional Techniques of Appendiceal Stump Closure in Laparoscopic Appendicectomy

Abstract

Acute appendicitis is one of the most commonly encountered surgical emergencies worldwide. The laparoscopic approach for managing acute appendicitis is gaining popularity over open appendicectomy in the current surgical practice. The advantages of laparoscopic appendectomy are early recovery, fewer wound complications, less pain and better cosmesis. One of the most critical steps in laparoscopic appendicectomy is a secure appendicular stump closure. Life-threatening postoperative complications are often encountered following the breakdown of appendicular stump closure. There are several methods to achieve appendicular stump closure such as intra-corporeal knotting, endoloops, external corporeal knotting and pushing knot inside, endoscopic linear cutting stapler (endo GIA), and endoclips. A meta-analysis on the technique of appendicular stump closure in laparoscopic appendicectomy failed to demonstrate the superiority of one method over the other. In the last few years, many authors have evaluated the outcome of sutureless appendicectomy performed using devices like a harmonic scalpel. This systematic review and meta-analysis is aimed to summarise the current evidence regarding the utility and safety of harmonic scalpel in sutureless appendicectomy.This systematic review and meta-analysis was conducted as per the preferred reporting items for systematic review and meta-analyses (PRISMA) guidelines. A systematic, detailed search was carried out by the authors in the electronic database, including Medline, Embase, CENTRAL, Scopus, Google scholar and clinical trial registry. Studies were selected and compared based on outcomes such as operative time, hospital stay, postoperative paralytic ileus, wound infection, and total complications. Statistical analysis was performed using the random effect model, fixed-effect model, pooled risk ratio, pooled mean difference and I 2 heterogeneity.Four comparative studies with a total of 642 patients (376 male and 266 females) were included in the analysis. There were 359 patients in the conventional technique of appendicular stump closure group and 283 patients in the harmonic scalpel for appendicular stump closure group. Pooled analysis of the outcome measure of total complications showed that the use of harmonic scalpel for closure of appendiceal stump does not result in an increased incidence of complications as compared to the conventional technology of appendiceal stump closure. Pooled analysis of the outcome measure of mean operative time revealed a statistically significant reduction in the operative time in the patients where harmonic scalpel has been used for the management of appendiceal stump as compared to conventional methods (pooled mean difference of -12.96 with 95% CI -15.42, -10.50). Appendiceal stump closure during laparoscopic appendectomy by harmonic scalpel (HS) is comparable with the conventional techniques in terms of hospital stay, wound infection, postoperative paralytic ileus, and total complications. The use of a harmonic scalpel for closure of appendic...

Usefulness of Harmonic ACE+7 Scalpel in Breast Reconstruction with Extended Latissimus Dorsi Flap: An Open-label Single Institution Pilot Study

“…In contrast, total drainage of the back increased in the HA group from a median of 1543.9 mL (260-1115 mL) to 1669.8 mL (90-985 mL); however, this difference was not statistically significant. The HA group showed no difference in the duration of drain placement in the back [median, EC 12.0 (10-14) versus HA 12.3 (10)(11)(12)(13)(14) days] and in the anterior chest [median, EC 6.3 (4-8) versus HA 5.9 (4-8) days].…”

“…This technique is expected to minimize collateral damage because it minimizes energy transfer to the surrounding tissue. 9 , 10 Ultrasonic scalpels have recently been reported to be useful in preventing seroma in mastectomies. 11 Additionally, a study using the Harmonic Focus+ Shears in LD flap reconstruction found that compared with electrocautery, the Harmonic Focus+ Shears were associated with reduced seroma formation, shorter drainage period operative time, and hospital stay.…”

Self-Locking Polymeric Clips Are Safe for the Closure of Appendiceal Stump in Laparoscopic Appendectomy

“…A recent systematic review concluded that in terms of the length of stay and postoperative complications, such as wound infection or postoperative ileus, a harmonic scalpel is similar. It has the only advantage of reducing the duration of the operation in comparison with conventional laparoscopic appendectomy techniques [ 13 ]. The main drawback of the harmonic scalpel is the price of disposable hand equipment [ 13 ].…”

“…It has the only advantage of reducing the duration of the operation in comparison with conventional laparoscopic appendectomy techniques [ 13 ]. The main drawback of the harmonic scalpel is the price of disposable hand equipment [ 13 ]. However, there is no consensus on the technical method for closing the appendix stump.…”