Page 15 - WJOLS - World Journal of Laparoscopic Surgery

Hemorrhoidectomy with Harmonic Scalpel vs Conventional Hemorrhoidectomy
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postoperative pain and bleeding. Recently, hemorrhoidectomy references
done with newly developed equipment has been reported to result
in less postoperative pain and bleeding, shorter operation times, 1. MacRae HM, Mcleod RS. Comparison of hemorrhoidal treatment
modalities. A meta-analysis. Dis Colon Rectum 1995;38(7):687–694.
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and shorter hospital stays. DOI: 10.1007/BF02048023.
The harmonic scalpel is an ultrasonically activated instrument 2. Moult HP, Aubert M, et al. Classical treatment of hemorrhoids. J Visc
with sound waves as its source of power, which vibrates at a rate Surg 2014;12:9.
of 55,000 times per second. It is known for its ability to coagulate 3. Fareed M, El-Awady S, et al. Randomized trial comparing
small and medium-sized vessels; thus potentially it may minimize Ligasure to closed Feguson hemorrhoidectomy. Tech Coloproctol
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postoperative swelling and edema to the surrounding tissue. 2009;13(3):243–246. DOI: 10.1007/s10151-009-0520-4.
The harmonic scalpel possesses the unique advantage of causing 4. Voutillainen PE, Haglund CH. Ultrasonically activated shears in
very little lateral thermal injury: <1.5 mm at the surgical site is thyroidectomies: a randomized trial. Ann Surg 2000;231(3):322–328.
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translated into decreased postoperative pain. 5. Jayne DG, Botterill I, et al. Randomized clinical trial of Ligasure vs
Pain following Milligan–Morgan procedure can be explained by conventional diathermy for day-case hemorrhoidectomy. Br J Sur
positioning the ligature onto the vascular root of the hemorrhoid, 2002;89(4):428–432. DOI: 10.1046/j.0007-1323.2002.02056.x.
while electrocautery and laser procedures cause significant heat 6. Bulus H, Tas A, et al. Evaluation of two hemorrhoidectomy techniques:
damage to the sensitive perihemorrhoid area. Reduction of this harmonic scalpel and Ferguson with electrocautery. Asian J Surg
heat is considered to be the main reason for decreasing the level of 2014;37(1):20–23. DOI: 10.1016/j.asjsur.2013.04.002.
pain after harmonic scalpel hemorrhoidectomy. This study clearly 7. Sgourakis G, Sotiropolos GC. Stapled vs Ferguson hemorrhoidectomy:
demonstrates the superior pain control profile of harmonic scalpel is there any evidence-based information? Int J Colorectal Dis
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in hemorrhoidectmy and less need for analgesics. 8. Gravie JF, Lehur PA, et al. Stapled hemorrhoidopexy vs Milligan–
Another positive aspect of harmonic scalpel hemorrhoidectomy Morgan procedure: a prospective, randomized, multicenter trial
is good hemostasis. Harmonic scalpel has proved to be effective in with 2-year postoperative follow up. Ann Surg 2005;242(1):29–35.
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larger blood vessels as explained by colorectal surgery. DOI: 10.1097/01.sla.0000169570.64579.31.
The harmonic scalpel hemorrhoidectomy requires patience 9. Ascanelli S, Gregorio C. Long short and long term results of
for cutting tissues and for good hemostasis, since the ultrasonic randomized, controlled, prospective trial. Chir Ital 2005;57:439–447.
scissors have a slower pace. It is important to avoid pulling the tissue 10. Hetzer FH, Demartines N. Stapled vs excision hemorrhoidectomy:
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conclusIon 12. Armstrong DN, Ambroze WL. Harmonic scalpel vs electrocautery
Harmonic scalpel hemorrhoidectomy is a safe and effective hemorrhoidectomy: a prospective evaluation. Dis Colon Rectum
2001;44(4):558–564. DOI: 10.1007/BF02234329.
procedure with fewer complications compared to conventional 13. Msika S, Deroide G, et al. Harmonic Scalel in laparoscopic colorectal
hemorrhoidectomy. Long-term follow-up with larger-scale studies surgery. Dis Colon Rectum 2001;44(3):432–435. DOI: 10.1007/
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