The Harmonic Scalpel Versus Electrocoagulation For Parotidectomy : A Meta-Analysis

Objective: Parotidectomy is the most classic and unequivocal intervention for parotid neoplasm.The operative outcomes and postoperative complications of parotidectomy between harmonic scalpel and electrocautery gained more prominence in physician.In spite of much research work within the past years,there was an obvious lack of randomized controlled trial to resolve this question.Hence,a quantitative and qualitative meta-analysis was essential to evaluate the differences in these two types of hemostasis method.Method:The major electronic databases,including Pubmed,Embase,Cochrane library,Google Scholar,China National Knowledge Infrastructure and Chinese Scientific and Technological Journal databases were using the key words “electrocautery”,“electrocoagulation”,“harmonic scalpel”,“ultrasonic scalpel”,“ultrasonic dissector”,“parotidectomy” and “parotid surgery”.9 articles were included in our systematic review and meta-analysis.The operative time,intraoperative blood loss,hospital stay,salivary fistula and transient facial nerve paralysis were the outcome measures.Odds ratios(ORs)with 95% confidence intervals(CIs)were employed to evaluate the effect size for categorical outcomes and mean differences(MDs)with 95% confidence intervals(CIs)for continuous outcomes.Results: In our meta-analysis,there was a significant reduction in transient facial nerve paralysis[OR:0.33,95%CI=(0.19,0.58),P=0.0001],operation time [mean difference:-20.97;95%CI=(-24.02,-17.92);P<0.00001],intraoperative blood loss [mean difference:-20.75,95%CI=(-22.32,-19.18);P<0.00001],and hospital stay [mean difference:-0.83;95%CI=(-1.10,-0.57);P<0.00001]in harmonic scalpel group compared with electrocautery group.However,there was no significant difference in salivary fistula[ORs: 0.30,95%CI=(0.08,1.14);P=0.08] between these two groups.Conclusion: This meta-analysis indicated that compared with electrocautery,harmonic scalpel(HS)was transcendent in the aspects of transient facial nerve paralysis,operative time,intraoperative blood loss,hospital stay.However,with respect to the salivary fistula,there was no significant difference between these two groups.The harmonic scalpel,as an efficient and useful instrument,was advocated in parotidectomy.