The Harmonic Scalpel versus Conventional Hemostasis for Neck Dissection: A Meta-Analysis of the Randomized Controlled Trials
Neck dissection is the most definitive and effective treatment for head and neck cancer. This systematic review aims to compare the efficacy and surgical outcomes of neck dissection between the harmonic scalpel and conventional surgical techniques and conduct a quantitative meta-analysis of the rand...
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| description | Neck dissection is the most definitive and effective treatment for head and neck cancer. This systematic review aims to compare the efficacy and surgical outcomes of neck dissection between the harmonic scalpel and conventional surgical techniques and conduct a quantitative meta-analysis of the randomized trials.
Randomized controlled trials (RCTs) were identified from the major electronic databases (MEDLINE, EMBASE and Cochrane Library) using the keywords ''harmonic scalpel'' and ''neck dissection,'' and a quantitative meta-analysis was conducted. The operative time and intraoperative bleeding were the primary outcome measures, and other parameters assessed included the drainage fluid volume and length of hospital stay.
Seven trials that met the inclusion criteria included 406 neck dissection cases (201 in the harmonic scalpel group). Compared with conventional surgical techniques, the HS group had an operative time that was significantly reduced by 29.3 minutes [mean difference: -29.29; 95% CI = (-44.26, -14.32); P=0.0001], a reduction in intraoperative bleeding by 141.1 milliliters [mean difference: -141.13; 95% CI = (-314.99, 32.73); P=0.11], and a reduction in drainage fluid volume by 64.9 milliliters [mean difference: -64.86; 95% CI = (-110.40, -19.32); P=0.005] , but it is not significant after removal of studies driving heterogeneity. There was no significant difference in the length of the hospital stay [mean difference: -0.21; 95% CI = (-0.48, 0.07); P=0.14].
This systematic review showed that using the harmonic scalpel for neck dissection significantly reduces the operative time and drainage fluid volume and that it is not associated with an increased length of hospital stay or perioperative complications. Therefore, the harmonic scalpel method is safe and effective for neck dissection. However, the statistical heterogeneity was high. Further studies are required to substantiate our findings. |
| doi_str_mv | 10.1371/journal.pone.0132476 |
| format | Article |
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Randomized controlled trials (RCTs) were identified from the major electronic databases (MEDLINE, EMBASE and Cochrane Library) using the keywords ''harmonic scalpel'' and ''neck dissection,'' and a quantitative meta-analysis was conducted. The operative time and intraoperative bleeding were the primary outcome measures, and other parameters assessed included the drainage fluid volume and length of hospital stay.
Seven trials that met the inclusion criteria included 406 neck dissection cases (201 in the harmonic scalpel group). Compared with conventional surgical techniques, the HS group had an operative time that was significantly reduced by 29.3 minutes [mean difference: -29.29; 95% CI = (-44.26, -14.32); P=0.0001], a reduction in intraoperative bleeding by 141.1 milliliters [mean difference: -141.13; 95% CI = (-314.99, 32.73); P=0.11], and a reduction in drainage fluid volume by 64.9 milliliters [mean difference: -64.86; 95% CI = (-110.40, -19.32); P=0.005] , but it is not significant after removal of studies driving heterogeneity. There was no significant difference in the length of the hospital stay [mean difference: -0.21; 95% CI = (-0.48, 0.07); P=0.14].
This systematic review showed that using the harmonic scalpel for neck dissection significantly reduces the operative time and drainage fluid volume and that it is not associated with an increased length of hospital stay or perioperative complications. Therefore, the harmonic scalpel method is safe and effective for neck dissection. However, the statistical heterogeneity was high. Further studies are required to substantiate our findings.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0132476</identifier><identifier>PMID: 26161897</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Analysis ; Bias ; Bleeding ; Blood Loss, Surgical ; Cancer ; Complications ; Control methods ; Dissection ; Drainage ; Drainage measurement ; Head & neck cancer ; Head and neck cancer ; Hemostasis ; Hemostasis, Surgical ; Hemostatics ; Heterogeneity ; Humans ; Identification methods ; Length of Stay ; Meta-analysis ; Neck Dissection ; Operative Time ; Plastic surgery ; Publication Bias ; Randomization ; Randomized Controlled Trials as Topic ; Reduction ; Surgery ; Surgical drains ; Surgical Instruments ; Surgical outcomes ; Systematic review</subject><ispartof>PloS one, 2015-07, Vol.10 (7), p.e0132476-e0132476</ispartof><rights>COPYRIGHT 2015 Public Library of Science</rights><rights>2015 Ren et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2015 Ren et al 2015 Ren et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-b5ec2dee6b9caf31d58f4e1110196cc2a2d28786e4d77b91f5611c046888852b3</citedby><cites>FETCH-LOGICAL-c692t-b5ec2dee6b9caf31d58f4e1110196cc2a2d28786e4d77b91f5611c046888852b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4498925/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4498925/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26161897$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Chu, Pei-Yi</contributor><creatorcontrib>Ren, Zhen-Hu</creatorcontrib><creatorcontrib>Xu, Jian-Lin</creatorcontrib><creatorcontrib>Fan, Teng-Fei</creatorcontrib><creatorcontrib>Ji, Tong</creatorcontrib><creatorcontrib>Wu, Han-Jiang</creatorcontrib><creatorcontrib>Zhang, Chen-Ping</creatorcontrib><title>The Harmonic Scalpel versus Conventional Hemostasis for Neck Dissection: A Meta-Analysis of the Randomized Controlled Trials</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Neck dissection is the most definitive and effective treatment for head and neck cancer. This systematic review aims to compare the efficacy and surgical outcomes of neck dissection between the harmonic scalpel and conventional surgical techniques and conduct a quantitative meta-analysis of the randomized trials.
Randomized controlled trials (RCTs) were identified from the major electronic databases (MEDLINE, EMBASE and Cochrane Library) using the keywords ''harmonic scalpel'' and ''neck dissection,'' and a quantitative meta-analysis was conducted. The operative time and intraoperative bleeding were the primary outcome measures, and other parameters assessed included the drainage fluid volume and length of hospital stay.
Seven trials that met the inclusion criteria included 406 neck dissection cases (201 in the harmonic scalpel group). Compared with conventional surgical techniques, the HS group had an operative time that was significantly reduced by 29.3 minutes [mean difference: -29.29; 95% CI = (-44.26, -14.32); P=0.0001], a reduction in intraoperative bleeding by 141.1 milliliters [mean difference: -141.13; 95% CI = (-314.99, 32.73); P=0.11], and a reduction in drainage fluid volume by 64.9 milliliters [mean difference: -64.86; 95% CI = (-110.40, -19.32); P=0.005] , but it is not significant after removal of studies driving heterogeneity. There was no significant difference in the length of the hospital stay [mean difference: -0.21; 95% CI = (-0.48, 0.07); P=0.14].
This systematic review showed that using the harmonic scalpel for neck dissection significantly reduces the operative time and drainage fluid volume and that it is not associated with an increased length of hospital stay or perioperative complications. Therefore, the harmonic scalpel method is safe and effective for neck dissection. However, the statistical heterogeneity was high. Further studies are required to substantiate our findings.</description><subject>Analysis</subject><subject>Bias</subject><subject>Bleeding</subject><subject>Blood Loss, Surgical</subject><subject>Cancer</subject><subject>Complications</subject><subject>Control methods</subject><subject>Dissection</subject><subject>Drainage</subject><subject>Drainage measurement</subject><subject>Head & neck cancer</subject><subject>Head and neck cancer</subject><subject>Hemostasis</subject><subject>Hemostasis, Surgical</subject><subject>Hemostatics</subject><subject>Heterogeneity</subject><subject>Humans</subject><subject>Identification methods</subject><subject>Length of Stay</subject><subject>Meta-analysis</subject><subject>Neck Dissection</subject><subject>Operative Time</subject><subject>Plastic surgery</subject><subject>Publication Bias</subject><subject>Randomization</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Reduction</subject><subject>Surgery</subject><subject>Surgical drains</subject><subject>Surgical Instruments</subject><subject>Surgical outcomes</subject><subject>Systematic 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methods</topic><topic>Length of Stay</topic><topic>Meta-analysis</topic><topic>Neck Dissection</topic><topic>Operative Time</topic><topic>Plastic surgery</topic><topic>Publication Bias</topic><topic>Randomization</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Reduction</topic><topic>Surgery</topic><topic>Surgical drains</topic><topic>Surgical Instruments</topic><topic>Surgical outcomes</topic><topic>Systematic review</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ren, Zhen-Hu</creatorcontrib><creatorcontrib>Xu, Jian-Lin</creatorcontrib><creatorcontrib>Fan, Teng-Fei</creatorcontrib><creatorcontrib>Ji, Tong</creatorcontrib><creatorcontrib>Wu, Han-Jiang</creatorcontrib><creatorcontrib>Zhang, Chen-Ping</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE 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one</jtitle><addtitle>PLoS One</addtitle><date>2015-07-10</date><risdate>2015</risdate><volume>10</volume><issue>7</issue><spage>e0132476</spage><epage>e0132476</epage><pages>e0132476-e0132476</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Neck dissection is the most definitive and effective treatment for head and neck cancer. This systematic review aims to compare the efficacy and surgical outcomes of neck dissection between the harmonic scalpel and conventional surgical techniques and conduct a quantitative meta-analysis of the randomized trials.
Randomized controlled trials (RCTs) were identified from the major electronic databases (MEDLINE, EMBASE and Cochrane Library) using the keywords ''harmonic scalpel'' and ''neck dissection,'' and a quantitative meta-analysis was conducted. The operative time and intraoperative bleeding were the primary outcome measures, and other parameters assessed included the drainage fluid volume and length of hospital stay.
Seven trials that met the inclusion criteria included 406 neck dissection cases (201 in the harmonic scalpel group). Compared with conventional surgical techniques, the HS group had an operative time that was significantly reduced by 29.3 minutes [mean difference: -29.29; 95% CI = (-44.26, -14.32); P=0.0001], a reduction in intraoperative bleeding by 141.1 milliliters [mean difference: -141.13; 95% CI = (-314.99, 32.73); P=0.11], and a reduction in drainage fluid volume by 64.9 milliliters [mean difference: -64.86; 95% CI = (-110.40, -19.32); P=0.005] , but it is not significant after removal of studies driving heterogeneity. There was no significant difference in the length of the hospital stay [mean difference: -0.21; 95% CI = (-0.48, 0.07); P=0.14].
This systematic review showed that using the harmonic scalpel for neck dissection significantly reduces the operative time and drainage fluid volume and that it is not associated with an increased length of hospital stay or perioperative complications. Therefore, the harmonic scalpel method is safe and effective for neck dissection. However, the statistical heterogeneity was high. Further studies are required to substantiate our findings.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>26161897</pmid><doi>10.1371/journal.pone.0132476</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Analysis Bias Bleeding Blood Loss, Surgical Cancer Complications Control methods Dissection Drainage Drainage measurement Head & neck cancer Head and neck cancer Hemostasis Hemostasis, Surgical Hemostatics Heterogeneity Humans Identification methods Length of Stay Meta-analysis Neck Dissection Operative Time Plastic surgery Publication Bias Randomization Randomized Controlled Trials as Topic Reduction Surgery Surgical drains Surgical Instruments Surgical outcomes Systematic review |
| title | The Harmonic Scalpel versus Conventional Hemostasis for Neck Dissection: A Meta-Analysis of the Randomized Controlled Trials |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-22T13%3A46%3A44IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=The%20Harmonic%20Scalpel%20versus%20Conventional%20Hemostasis%20for%20Neck%20Dissection:%20A%20Meta-Analysis%20of%20the%20Randomized%20Controlled%20Trials&rft.jtitle=PloS%20one&rft.au=Ren,%20Zhen-Hu&rft.date=2015-07-10&rft.volume=10&rft.issue=7&rft.spage=e0132476&rft.epage=e0132476&rft.pages=e0132476-e0132476&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0132476&rft_dat=%3Cgale_plos_%3EA421278197%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1695377932&rft_id=info:pmid/26161897&rft_galeid=A421278197&rft_doaj_id=oai_doaj_org_article_c3856325238f44f280c2fb355195a4aa&rfr_iscdi=true |