The safety of harmonic scalpel <i>versus</i> conventional resection in superficial parotidectomy: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

ZHAO Jinzhu , ZHENG Xiangqian ,  GAO Ming , CHI Jiadong , YUN Xinwei

Department of Thyroid and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, P.R.China;

Corresponding author：

GAO Ming, Email: headandneck15@aliyun.com

Keywords：

Superficial parotidectomy; Harmonic scalpel; Conventional resection; Meta-analysis; Systematic review; Randomized controlled trial; Cohort study

DOI：

10.7507/1672-2531.201903077

Video：

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Objectives To systematically review the safety of harmonic scalpel and conventional resection in superficial parotidectomy.Methods PubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and CBM databases were electronically searched to collect randomized controlled trials (RCTs) or cohort studies of harmonic scalpel and conventional resection in superficial parotidectomy from the inception of the database to December, 2018. Two reviewers independently screened literatures, extracted data and assessed risk of bias of the included studies. Then meta-analysis was performed by using RevMan 5.3 software.Results A total of 10 studies involving 671 post-cesarean section patients (361 patients in harmonic scalpel group and 310 patients in conventional resection group) were included. The results of meta-analysis showed that: compared with conventional resection, harmonic scalpel had shorter operative time (MD=−23.82, 95%CI −31.20 to −16.44, P<0.000 01), less postoperative drain output (MD=−26.25, 95%CI −38.95 to −13.55, P<0.000 1), less intraoperative blood loss (MD=−23.78, 95%CI −28.64 to −18.91, P<0.000 01), shorter duration of hospital stay (MD=−1.19, 95%CI −2.14 to −0.23, P=0.02), and lower temporary facial nerve palsy rate (OR=0.27, 95%CI 0.14 to 0.50, P<0.000 1). However, there was no significant difference in the incidence of parotid gland leakage between two groups (OR=0.42, 95%CI 0.16 to 1.06, P=0.07).Conclusions The current evidence demonstrates that, compared to conventional resection, harmonic scalpel resection is safer. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusions.

Citation： ZHAO Jinzhu, ZHENG Xiangqian, GAO Ming, CHI Jiadong, YUN Xinwei. The safety of harmonic scalpel versus conventional resection in superficial parotidectomy: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2019, 19(9): 1070-1077. doi: 10.7507/1672-2531.201903077 Copy

1.	Zheng CY, Cao R, Gao MH, et al. Comparison of surgical techniques for benign parotid tumours: a multicentre retrospective study. Int J Oral Maxillofac Surg, 2019, 48(2): 187-192.
2.	Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions (version 5.1.0). The Cochrane Collaboration, 2011. Available at: http://www.cochrane-handbook.org.
3.	Wells G, Shea B, Oconnell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses, 2000. Available at: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
4.	Salami A, Dellepiane M, Bavazzano M, et al. New trends in head and neck surgery: a prospective evaluation of the Harmonic Scalpel. Med Sci Monit, 2008, 14(5): 1-5.
5.	Blankenship DR, Gourin CG, Porubsky EA, et al. Harmonic scalpel versus cold knife dissection in superficial parotidectomy. Otolaryngol Head Neck Surg, 2004, 131(4): 397-400.
6.	Muhanna N, Peleg U, Schwartz Y, et al. Harmonic scalpel assisted superficial parotidectomy. Ann Otol Rhinol Laryngol, 2014, 123(9): 636-640.
7.	余晓旭, 李彬, 冯勇, 等. 超声刀在腮腺肿瘤手术中的应用. 临床合理用药杂志, 2018, 11(4): 60-61, 63.
8.	张建中, 李静远, 赵耀新, 等. 超声刀在腮腺浅叶功能性手术中的应用. 中国肿瘤外科杂志, 2015, 7(2): 112-113.
9.	王旭东, 吴延升, 曹晓莉, 等. Focus超声刀在开放性腮腺手术中的应. 中华口腔医学杂志, 2010, 45(6): 384.
10.	赵璧, 张继生, 尹林, 等. 超声刀在腮腺手术中的应用. 临床口腔医学杂志, 2015, 31(1): 48-50.
11.	辛运超, 林彦涛, 薛刚, 等. 超声刀和电刀在腮腺手术中的应用研究. 临床耳鼻咽喉头颈外科杂志, 2014, 28(21): 1705-1707.
12.	邓廷超, 陈睿. 超声刀与单极电刀在腮腺浅叶切除术中的临床应用比较分析. 重庆医科大学, 2019, 44(1): 119-122.
13.	Polacco MA, Pintea AM, Gosselin BJ, et al. Parotidectomy using the Harmonic scalpel: ten years of experience at a rural academic health center. Head Face Med, 2017, 13(1): 8.
14.	Koch C, Friedrich T, Metternich F, et al. Determination of temperature elevation in tissue during the application of the harmonic scalpel. Ultrasound Med Biol, 2003, 29(2): 301-309.
15.	Tirelli G, Camilot D, Bonini P, et al. Harmonic scalpel and electrothermal bipolar vessel sealing system in head and neck surgery: a prospective study on tissue heating and histological damage on nerves. Ann Otol Rhinol Laryngol, 2015, 124(11): 852-858.
16.	Gilbey P, Gadban H, Letichevsky V, et al. Harmonic scalpel tonsillectomy using the curved shears instrument versus cold dissection tonsillectomy: a retrospective study. Ann Otol Rhinol Laryngol, 2008, 117(1): 46-50.
17.	Collison PJ, Weiner R. Harmonic scalpel versus conventional tonsillectomy: a double-blind clinical trial. Ear Nose Throat J, 2004, 83(10): 707-710.
18.	Metternich FU, Sagowski C, Wenzel S, et al. Preliminary results for superficial parotidectomy using the ultrasonically activated scalpel (Ultracision Harmonic Scalpel). Laryngorhinootologie, 2003, 82(7): 514-519.
19.	Ecker T, Carvalho AL, Choe JH, et al. Hemostasis in thyroid surgery: harmonic scalpel versus other techniques-a meta-analysis. Otolaryngol Head Neck Surg, 2010, 143(1): 17-25.
20.	Coulson SE, O'dwyer NJ, Adams RD, et al. Expression of emotion and quality of life after facial nerve paralysis. Otol Neurotol, 2004, 25(6): 1014-1019.
21.	Gaillard C, Périé S, Susini B, et al. Facial nerve dysfunction after parotidectomy: the role of local factors. Laryngoscope, 2005, 115(2): 287-291.
22.	Prats-Golczer VE, Gonzalez-Cardero E, Exposito-Tirado JA, et al. Impact of dysfunction of the facial nerve after superficial parotidectomy: a prospective study. Br J Oral Maxillofac Surg, 2017, 55(8): 798-802.
23.	Jackson LL, Gourin CG, Thomas DS, et al. Use of the harmonic scalpel in superficial and total parotidectomy for benign and malignant disease. Laryngoscope, 2005, 115(6): 1070-1073.
24.	Owaki T, Nakano S, Arimura K, et al. The ultrasonic coagulating and cutting system injure nerve function. Endoscopy, 2002, 34(7): 575-579.
25.	Lee KE, Jee HG, Kim HY, et al. Development of a canine model for recurrent laryngeal injury by harmonic scalpel. Lab Anim Res, 2012, 28(4): 223-228.
26.	Britt CJ, Stein AP, Gessert T, et al. Factors influencing sialocele or salivary fistula formation postparotidectomy. Head Neck, 2017, 39(2): 387-391.
27.	Li D, Kou Y, Huang S, et al. The harmonic scalpel versus electrocautery for parotidectomy: a meta-analysis. J Craniomaxillofac Surg, 2019, 47(6): 915-921.
28.	Zhao Bi, Chen Juan, Yang Xinhua, et al. Study on the relationship between the ultrasonic scalpel and parotid salivary fistula after operation. China Contin Med Educ, 2015, 24: 84-85.

1. Zheng CY, Cao R, Gao MH, et al. Comparison of surgical techniques for benign parotid tumours: a multicentre retrospective study. Int J Oral Maxillofac Surg, 2019, 48(2): 187-192.
2. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions (version 5.1.0). The Cochrane Collaboration, 2011. Available at: http://www.cochrane-handbook.org.
3. Wells G, Shea B, Oconnell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses, 2000. Available at: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
4. Salami A, Dellepiane M, Bavazzano M, et al. New trends in head and neck surgery: a prospective evaluation of the Harmonic Scalpel. Med Sci Monit, 2008, 14(5): 1-5.
5. Blankenship DR, Gourin CG, Porubsky EA, et al. Harmonic scalpel versus cold knife dissection in superficial parotidectomy. Otolaryngol Head Neck Surg, 2004, 131(4): 397-400.
6. Muhanna N, Peleg U, Schwartz Y, et al. Harmonic scalpel assisted superficial parotidectomy. Ann Otol Rhinol Laryngol, 2014, 123(9): 636-640.
7. 余晓旭, 李彬, 冯勇, 等. 超声刀在腮腺肿瘤手术中的应用. 临床合理用药杂志, 2018, 11(4): 60-61, 63.
8. 张建中, 李静远, 赵耀新, 等. 超声刀在腮腺浅叶功能性手术中的应用. 中国肿瘤外科杂志, 2015, 7(2): 112-113.
9. 王旭东, 吴延升, 曹晓莉, 等. Focus超声刀在开放性腮腺手术中的应. 中华口腔医学杂志, 2010, 45(6): 384.
10. 赵璧, 张继生, 尹林, 等. 超声刀在腮腺手术中的应用. 临床口腔医学杂志, 2015, 31(1): 48-50.
11. 辛运超, 林彦涛, 薛刚, 等. 超声刀和电刀在腮腺手术中的应用研究. 临床耳鼻咽喉头颈外科杂志, 2014, 28(21): 1705-1707.
12. 邓廷超, 陈睿. 超声刀与单极电刀在腮腺浅叶切除术中的临床应用比较分析. 重庆医科大学, 2019, 44(1): 119-122.
13. Polacco MA, Pintea AM, Gosselin BJ, et al. Parotidectomy using the Harmonic scalpel: ten years of experience at a rural academic health center. Head Face Med, 2017, 13(1): 8.
14. Koch C, Friedrich T, Metternich F, et al. Determination of temperature elevation in tissue during the application of the harmonic scalpel. Ultrasound Med Biol, 2003, 29(2): 301-309.
15. Tirelli G, Camilot D, Bonini P, et al. Harmonic scalpel and electrothermal bipolar vessel sealing system in head and neck surgery: a prospective study on tissue heating and histological damage on nerves. Ann Otol Rhinol Laryngol, 2015, 124(11): 852-858.
16. Gilbey P, Gadban H, Letichevsky V, et al. Harmonic scalpel tonsillectomy using the curved shears instrument versus cold dissection tonsillectomy: a retrospective study. Ann Otol Rhinol Laryngol, 2008, 117(1): 46-50.
17. Collison PJ, Weiner R. Harmonic scalpel versus conventional tonsillectomy: a double-blind clinical trial. Ear Nose Throat J, 2004, 83(10): 707-710.
18. Metternich FU, Sagowski C, Wenzel S, et al. Preliminary results for superficial parotidectomy using the ultrasonically activated scalpel (Ultracision Harmonic Scalpel). Laryngorhinootologie, 2003, 82(7): 514-519.
19. Ecker T, Carvalho AL, Choe JH, et al. Hemostasis in thyroid surgery: harmonic scalpel versus other techniques-a meta-analysis. Otolaryngol Head Neck Surg, 2010, 143(1): 17-25.
20. Coulson SE, O'dwyer NJ, Adams RD, et al. Expression of emotion and quality of life after facial nerve paralysis. Otol Neurotol, 2004, 25(6): 1014-1019.
21. Gaillard C, Périé S, Susini B, et al. Facial nerve dysfunction after parotidectomy: the role of local factors. Laryngoscope, 2005, 115(2): 287-291.
22. Prats-Golczer VE, Gonzalez-Cardero E, Exposito-Tirado JA, et al. Impact of dysfunction of the facial nerve after superficial parotidectomy: a prospective study. Br J Oral Maxillofac Surg, 2017, 55(8): 798-802.
23. Jackson LL, Gourin CG, Thomas DS, et al. Use of the harmonic scalpel in superficial and total parotidectomy for benign and malignant disease. Laryngoscope, 2005, 115(6): 1070-1073.
24. Owaki T, Nakano S, Arimura K, et al. The ultrasonic coagulating and cutting system injure nerve function. Endoscopy, 2002, 34(7): 575-579.
25. Lee KE, Jee HG, Kim HY, et al. Development of a canine model for recurrent laryngeal injury by harmonic scalpel. Lab Anim Res, 2012, 28(4): 223-228.
26. Britt CJ, Stein AP, Gessert T, et al. Factors influencing sialocele or salivary fistula formation postparotidectomy. Head Neck, 2017, 39(2): 387-391.
27. Li D, Kou Y, Huang S, et al. The harmonic scalpel versus electrocautery for parotidectomy: a meta-analysis. J Craniomaxillofac Surg, 2019, 47(6): 915-921.
28. Zhao Bi, Chen Juan, Yang Xinhua, et al. Study on the relationship between the ultrasonic scalpel and parotid salivary fistula after operation. China Contin Med Educ, 2015, 24: 84-85.

Chinese Journal of Evidence-Based Medicine

The safety of harmonic scalpel versus conventional resection in superficial parotidectomy: a meta-analysis

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