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World Journal of Surgical Oncology
Published in: World Journal of Surgical Oncology 1/2018

Open Access 01-12-2018 | Review

Performance of Harmonic devices in surgical oncology: an umbrella review of the evidence

Authors: Hang Cheng, Jeffrey W. Clymer, Behnam Sadeghirad, Nicole C. Ferko, Chris G. Cameron, Joseph F. Amaral

Published in: World Journal of Surgical Oncology | Issue 1/2018

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Abstract

Background

We performed an umbrella review of systematic reviews summarizing the evidence on the Harmonic scalpel (HS) compared with conventional techniques in surgical oncology (including lymph node dissection).

Methods

We searched MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews from inception to end of March of 2017 for meta-analyses or systematic reviews of randomized trials comparing HS to conventional techniques in surgical oncology. We assessed the quality of included systematic reviews with AMSTAR (A MeaSurement Tool to Assess systematic Reviews) and assessed the certainty in evidence for each pooled outcome using GRADE (Grading of Recommendations Assessment, Development, and Evaluation).

Results

We identified ten systematic reviews on breast cancer (n = 3), gastric cancers (n = 3), oral, head, and neck cancers (n = 1), and colon cancers (n = 3). Most reviews received a higher rating using AMSTAR. For operative time, systematic reviews reported a reduction of 25 to 29 min for HS compared with conventional methods across oncology types, with the exception of breast cancer where little differences were observed (very low to moderate quality of evidence (GRADE)). For blood loss and drainage volume, the majority of reviews reported statistically significant reductions with HS, and reductions ranged from 42 to 141 mL, and from 42 to 292 mL, respectively (very low to moderate quality of evidence). Hospitalization days were reported to decrease with use of HS by 0.2 to 3.2 days; however, reductions were only statistically significant for half of the included reviews (low to moderate quality of evidence). Regarding perioperative complications, two of six reviews reported a significantly reduced risk with HS use (breast cancer surgery) (moderate to high quality evidence)).

Conclusion

Across surgical oncology types, the majority of included systematic reviews showed a statistically significant or numerical improvement in surgical outcomes with use of the HS compared with conventional methods. Well-designed randomized studies with large sample sizes will help to provide more precise estimates and reduce the risk of heterogeneity.
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Literature
1.
Kennedy J, Buysse S, Lawes K, Ryan T. Recent innovations in bipolar electrosurgery. Minim Invasive Ther Allied Technol. 1999;8:95–9.CrossRef
2.
Carroll T, Ladner K, Meyers AD. Alternative surgical dissection techniques. Otolaryngol Clin N Am. 2005;38:397–411.CrossRef
3.
Devassy R, Gopalakrishnan S, De Wilde RL. Surgical efficacy among laparoscopic ultrasonic dissectors: are we advancing safely? A review of literature. J Obstet Gynaecol India. 2015;65:293–300.CrossRefPubMedPubMedCentral
4.
Lyons SD, Law KSK. Laparoscopic vessel sealing technologies. J Minim Invasive Gynecol. 2013;20:301–7.CrossRefPubMed
5.
Amaral JF. Ultrasonic dissection. Endoscopic Surgery and Allied Technologies. 1994;2:181–5.PubMed
6.
Timm RW, Asher RM, Tellio KR, Welling AL, Clymer JW, Amaral JF. Sealing vessels up to 7 mm in diameter solely with ultrasonic technology. Med Devices (Auckl). 2014;7:263–71.
7.
Law KS, Abbott JA, Lyons SD. Energy sources for gynecologic laparoscopic surgery: a review of the literature. Obstet Gynecol Surv. 2014;69:763–76.CrossRefPubMed
8.
Wang K, Advincula AP. “Current thoughts” in electrosurgery. Int J Gynaecol Obstet. 2007;97:245–50.CrossRefPubMed
9.
Druzijanic N, Pogorelic Z, Perko Z, Mrklic I, Tomic S. Comparison of lateral thermal damage of the human peritoneum using monopolar diathermy, Harmonic scalpel and LigaSure. Can J Surg. 2012;55:317–21.CrossRefPubMedPubMedCentral
10.
Pogorelic Z, Katic J, Mrklic I, Jeroncic A, Susnjar T, Jukic M, Vilovic K, Perko Z. Lateral thermal damage of mesoappendix and appendiceal base during laparoscopic appendectomy in children: comparison of the harmonic scalpel (Ultracision), bipolar coagulation (LigaSure), and thermal fusion technology (MiSeal). J Surg Res. 2017;212:101–7.CrossRefPubMed
11.
Alexiou VG, Salazar-Salvia MS, Jervis PN, Falagas ME. Modern technology-assisted vs conventional tonsillectomy: a meta-analysis of randomized controlled trials. Arch Otolaryngol Head Neck Surg. 2011;137:558–70.CrossRefPubMed
12.
Cheng H, Hsiao CW, Clymer JW, Schwiers ML, Tibensky BN, Patel L, Ferko NC, Chekan E. Gastrectomy and D2 lymphadenectomy for gastric cancer: a meta-analysis comparing the harmonic scalpel to conventional techniques. Int J Surg Oncol. 2015;2015:397260.PubMedPubMedCentral
13.
Huang J, Yu Y, Wei C, Qin Q, Mo Q, Yang W. Harmonic Scalpel versus electrocautery dissection in modified radical mastectomy for breast cancer: a meta-analysis. PLoS One. 2015;10:e0142271.CrossRefPubMedPubMedCentral
14.
Ren ZH, JL X, Fan TF, Ji T, HJ W, Zhang CP. The harmonic scalpel versus conventional hemostasis for neck dissection: a meta-analysis of the randomized controlled trials. PLoS One. 2015;10:e0132476.CrossRefPubMedPubMedCentral
15.
Revelli L, Damiani G, Bianchi CB, Vanella S, Ricciardi W, Raffaelli M, Lombardi CP. Complications in thyroid surgery. Harmonic Scalpel, Harmonic Focus versus Conventional Hemostasis: a meta-analysis. Int J Surg. 2016;28(Suppl 1):S22–32.CrossRefPubMed
16.
Simillis C, Thoukididou SN, Slesser AA, Rasheed S, Tan E, Tekkis PP. Systematic review and network meta-analysis comparing clinical outcomes and effectiveness of surgical treatments for haemorrhoids. Br J Surg. 2015;102:1603–18.CrossRefPubMed
17.
Jiang HP, Liu YD, Li YS, Shen ZL, Ye YJ. Ultrasonic versus electrosurgical device for laparoscopic cholecystectomy: a systematic review with meta-analysis and trial sequential analysis. Int J Surg. 2017;40:24–32.CrossRefPubMed
18.
Aromataris E, Fernandez R, Godfrey CM, Holly C, Khalil H, Tungpunkom P. Summarizing systematic reviews: methodological development, conduct and reporting of an umbrella review approach. Int J Evid Based Healthc. 2015;13:132–40.CrossRefPubMed
19.
Smith V, Devane D, Begley CM, Clarke M. Methodology in conducting a systematic review of systematic reviews of healthcare interventions. BMC Med Res Methodol. 2011;11:15.CrossRefPubMedPubMedCentral
20.
Sabel MS, Diehl KM, Chang AE: Principles of surgical therapy in oncology. In Oncology: An Evidence-Based Approach. Chang AE, Hayes DF, Pass HI, Stone RM, Ganz PA, Kinsella TJ, Schiller JH, Strecher VJ. New York, NY: Springer New York; 2006: 58–72.CrossRef
21.
Cheng H, Clymer JW, Ferko NC, Patel L, Soleas IM, Cameron CG, Hinoul P. A systematic review and meta-analysis of Harmonic technology compared with conventional techniques in mastectomy and breast-conserving surgery with lymphadenectomy for breast cancer. Breast Cancer (Dove Med Press). 2016;8:125–40.
22.
Currie A, Chong K, Davies GL, Cummins RS. Ultrasonic dissection versus electrocautery in mastectomy for breast cancer—a meta-analysis. Eur J Surg Oncol. 2012;38:897–901.CrossRefPubMed
23.
Chen XL, Chen XZ, ZH L, Wang L, Yang K, JK H, Zhang B, Chen ZX, Chen JP, Zhou ZG. Comparison of ultrasonic scalpel versus conventional techniques in open gastrectomy for gastric carcinoma patients: a systematic review and meta-analysis. PLoS One. 2014;9:e103330.CrossRefPubMedPubMedCentral
24.
Sun ZC, WG X, Xiao XM, WH Y, DM X, HM X, Gao HL, Wang RX. Ultrasonic dissection versus conventional electrocautery during gastrectomy for gastric cancer: a meta-analysis of randomized controlled trials. Eur J Surg Oncol. 2015;41:527–33.CrossRefPubMed
25.
Higgins JP, Green S. (Eds.). Cochrane handbook for systematic reviews of interventions. Wiley. 2011;4.
26.
Shea BJ, Hamel C, Wells GA, Bouter LM, Kristjansson E, Grimshaw J, Henry DA, Boers M. AMSTAR is a reliable and valid measurement tool to assess the methodological quality of systematic reviews. J Clin Epidemiol. 2009;62:1013–20.CrossRefPubMed
27.
28.
Allaix ME, Furnee EJ, Arezzo A, Mistrangelo M, Morino M. Energy sources for laparoscopic colorectal surgery: is one better than the others? J Laparoendosc Adv Surg Tech A. 2016;26:264–9.CrossRefPubMed
29.
Di Lorenzo N, Franceschilli L, Allaix ME, Asimakopoulos AD, Sileri P, Gaspari AL. Radiofrequency versus ultrasonic energy in laparoscopic colorectal surgery: a metaanalysis of operative time and blood loss. Surg Endosc. 2012;26:2917–24.CrossRefPubMed
30.
Tou S, Malik AI, Wexner SD, Nelson RL. Energy source instruments for laparoscopic colectomy. Cochrane Database Syst Rev. 2011;5:Cd007886.
31.
SY O, Choi B, Lee KG, Choe HN, Lee HJ, Suh YS, Kong SH, Lee HJ, Kim WH, Yang HK. Ultrasonically activated shears reduce blood loss without increasing inflammatory reactions in open distal gastrectomy for cancer: a randomized controlled study. Ann Surg Oncol. 2017;24:494–501.CrossRef
32.
Kawabata R, Takiguchi S, Kimura Y, Imamura H, Fujita J, Tamura S, Fujitani K, Kishi K, Yamamoto K, Fujiwara S, et al. A randomized phase II study of the clinical effects of ultrasonically activated coagulating shears (Harmonic scalpel) in open gastrectomy for gastric cancer. Surg Today. 2016;46:561–8.CrossRefPubMed
33.
Abul Nagah G, Tarek E, Lotfy H, Shehab W, Tarek A. Comparative study between using harmonic scalpel and electrocautery in modified radical mastectomy. Egyptian Journal of Surgery. 2007;26:176–80.
34.
Lumachi F, Basso SM, Santeufemia DA, Bonamini M, Chiara GB. Ultrasonic dissection system technology in breast cancer: a case-control study in a large cohort of patients requiring axillary dissection. Breast Cancer Res Treat. 2013;142:399–404.CrossRefPubMed
35.
Manjunath S, Ramesh RS, K S, Goel V. Ultrasonic shears versus electrocautery in axillary dissection for breast cancer—a randomized controlled trial. Indian J Surg Oncol. 2014;5:95–8.CrossRefPubMedPubMedCentral
36.
Nawaz A, Waqar S, Khan A, Mansoor R, Butt UI, Ayyaz M. Harmonic scalpel versus electrocautery in axillary dissection in carcinoma breast. J Coll Physicians Surg Pak. 2015;25:870–3.PubMed
37.
He Q, Zhuang D, Zheng L, Zhou P, Chai J, Lv Z. Harmonic focus in total thyroidectomy plus level III-IV and VI dissection: a prospective randomized study. World J Surg Oncol. 2011;9:141.CrossRefPubMedPubMedCentral
38.
Sista F, Abruzzese V, Schietroma M, Cecilia EM, Mattei A, Amicucci G. New harmonic scalpel versus conventional hemostasis in right colon surgery: a prospective randomized controlled clinical trial. Dig Surg. 2013;30:355–61.CrossRefPubMed
39.
Wilhelm D, Szabo M, Glass F, Schuhmacher C, Friess H, Feussner H. Randomized controlled trial of ultrasonic dissection versus standard surgical technique in open left hemicolectomy or total gastrectomy. Br J Surg. 2011;98:220–7.CrossRefPubMed
40.
Anlar B, Karaman N, Dogan L, Ozaslan C, Atalay C, Altinok M. The effect of harmonic scalpel, electrocautery, and scalpel use on early wound complications after modified radical mastectomy. Eur Surg. 2013;45:286–90.CrossRef
41.
Ferri E, Armato E, Spinato G, Lunghi M, Tirelli G, Spinato R. Harmonic scalpel versus conventional haemostasis in neck dissection: a prospective randomized study. Int J Surg Oncol. 2013;2013:369345.PubMedPubMedCentral
42.
He Q, Zhuang D, Zheng L, Fan Z, Zhou P, Zhu J, Lv Z, Chai J, Cao L. Harmonic focus versus electrocautery in axillary lymph node dissection for breast cancer: a randomized clinical study. Clin Breast Cancer. 2012;12:454–8.CrossRefPubMed
43.
Hubner M, Demartines N, Muller S, Dindo D, Clavien PA, Hahnloser D. Prospective randomized study of monopolar scissors, bipolar vessel sealer and ultrasonic shears in laparoscopic colorectal surgery. Br J Surg. 2008;95:1098–104.CrossRefPubMed
44.
Inoue K, Nakane Y, Michiura T, Yamada M, Mukaide H, Fukui J, Miki H, Ueyama Y, Nakatake R, Tokuhara K, et al. Ultrasonic scalpel for gastric cancer surgery: a prospective randomized study. J Gastrointest Surg. 2012;16:1840–6.CrossRefPubMed
45.
Droeser RA, Frey DM, Oertli D, Kopelman D, Baas-Vrancken Peeters MJ, Giuliano AE, Dalberg K, Kallam R, Nordmann A. Volume-controlled vs no/short-term drainage after axillary lymph node dissection in breast cancer surgery: a meta-analysis. Breast. 2009;18:109–14.CrossRefPubMed
46.
47.
Harrell GJ, Kopps DR. Minimizing patient risk during laparoscopic electrosurgery. AORN J. 1998;67:1194–6. 1199-1205; quiz 1206-1110CrossRefPubMed
48.
Tucker RD, Voyles CR. Laparoscopic electrosurgery: complications and prevention. Surg Technol Int. 1993;2:131–5.PubMed
49.
Miccoli P, Berti P, Raffaelli M, Materazzi G, Conte M, Galleri D. Impact of harmonic scalpel on operative time during video-assisted thyroidectomy. Surg Endosc. 2002;16:663–6.CrossRefPubMed
50.
Mehta NY, Haluck RS, Frecker MI, Snyder AJ. Sequence and task analysis of instrument use in common laparoscopic procedures. Surg Endosc. 2002;16:280–5.CrossRefPubMed
51.
Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer. 2017;20:1–19.
52.
Fisher B, Jeong JH, Anderson S, Bryant J, Fisher ER, Wolmark N. Twenty-five-year follow-up of a randomized trial comparing radical mastectomy, total mastectomy, and total mastectomy followed by irradiation. N Engl J Med. 2002;347:567–75.CrossRefPubMed
53.
Javid M, Graham E, Malinowski J, Quinn CE, Carling T, Udelsman R, Callender GG. Dissection of levels II through V is required for optimal outcomes in patients with lateral neck lymph node metastasis from papillary thyroid carcinoma. J Am Coll Surg. 2016;222:1066–73.CrossRefPubMed
54.
Lucci A, McCall LM, Beitsch PD, Whitworth PW, Reintgen DS, Blumencranz PW, Leitch AM, Saha S, Hunt KK, Giuliano AE. Surgical complications associated with sentinel lymph node dissection (SLND) plus axillary lymph node dissection compared with SLND alone in the American College of Surgeons Oncology Group Trial Z0011. J Clin Oncol. 2007;25:3657–63.CrossRefPubMed
55.
Salvia R, Malleo G, Marchegiani G, Butturini G, Esposito A, Bassi C. Pancreaticoduodenectomy with harmonic focust curved shears for cancer. Dig Surg. 2014;31:249–54.CrossRefPubMed
56.
Porter KA, O'Connor S, Rimm E, Lopez M. Electrocautery as a factor in seroma formation following mastectomy. Am J Surg. 1998;176:8–11.CrossRefPubMed
57.
Manouras A, Markogiannakis H, Genetzakis M, Filippakis GM, Lagoudianakis EE, Kafiri G, Filis K, Zografos GC. Modified radical mastectomy with axillary dissection using the electrothermal bipolar vessel sealing system. Arch Surg. 2008;143:575–80. discussion 581CrossRefPubMed
58.
Hoenig DM, Chrostek CA, Amaral JF. Laparosonic coagulating shears: alternative method of hemostatic control of unsupported tissue. J Endourol. 1996;10:431–3.CrossRefPubMed
59.
Hoefer RA Jr, DuBois JJ, Ostrow LB, Silver LF. Wound complications following modified radical mastectomy: an analysis of perioperative factors. J Am Osteopath Assoc. 1990;90:47–53.PubMed
60.
Yilmaz KB, Dogan L, Nalbant H, Akinci M, Karaman N, Ozaslan C, Kulacoglu H. Comparing scalpel, electrocautery and ultrasonic dissector effects: the impact on wound complications and pro-inflammatory cytokine levels in wound fluid from mastectomy patients. J Breast Cancer. 2011;14:58–63.CrossRefPubMedPubMedCentral
61.
62.
Marutsuka T, Shimada S, Shiomori K, Hayashi N, Yagi Y, Yamane T, Ogawa M. Mechanisms of peritoneal metastasis after operation for non-serosa-invasive gastric carcinoma: an ultrarapid detection system for intraperitoneal free cancer cells and a prophylactic strategy for peritoneal metastasis. Clin Cancer Res. 2003;9:678–85.PubMed
63.
Nanduri B, Pendarvis K, Shack LA, Kumar R, Clymer JW, Korvick DL, Burgess SC. Ultrasonic incisions produce less inflammatory mediator response during early healing than electrosurgical incisions. PLoS One. 2013;8:e73032.CrossRefPubMedPubMedCentral
64.
Guyatt GH, Oxman AD, Kunz R, Vist GE, Falck-Ytter Y, Schunemann HJ. What is “quality of evidence” and why is it important to clinicians? BMJ. 2008;336:995–8.CrossRefPubMedPubMedCentral
65.
Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, Schunemann HJ. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336:924–6.CrossRefPubMedPubMedCentral
Metadata
Title
Performance of Harmonic devices in surgical oncology: an umbrella review of the evidence
Authors
Hang Cheng
Jeffrey W. Clymer
Behnam Sadeghirad
Nicole C. Ferko
Chris G. Cameron
Joseph F. Amaral
Publication date
01-12-2018
Publisher
BioMed Central
Published in
World Journal of Surgical Oncology / Issue 1/2018
Electronic ISSN: 1477-7819
DOI
https://doi.org/10.1186/s12957-017-1298-x

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