Harmonic Scalpel versus cold knife dissection in superficial parotidectomy

Use of the Harmonic Scalpel has recently been described in thyroid surgery, in which it appears to result in decreased operative time and blood loss without increasing the incidence of nerve injury when compared to conventional techniques of vessel ligation and tissue division. We sought to determine whether the use of the Harmonic Scalpel in superficial parotidectomy was associated with a difference in operative time, blood loss, or facial nerve injury compared with conventional techniques. The medical records of all patients who underwent superficial parotidectomy for benign parotid pathology at the Medical College of Georgia and Veterans Affairs Hospital of Augusta, Georgia, from 1999 to 2002 were retrospectively reviewed. Patients were excluded if they had a history of a bleeding disorder, prior facial nerve weakness, prior parotid surgery, malignant pathology, or required total parotidectomy. Forty-two patients were eligible for inclusion. Nineteen patients underwent Harmonic Scalpel parotidectomy (HS) and 21 patients underwent conventional parotidectomy (control group). There were no significant differences between the 2 groups with respect to demographic data, pathology, or tumor size. Use of the Harmonic Scalpel was associated with a significant reduction in length of surgery (167.5 ± 42.6 min vs. 195.5 ± 37.4 min for controls, P = 0.03) and intraoperative blood loss (37.5 ± 25.8 mL vs. 60.0 ± 37.1 mL for controls, P = 0.03). There were no significant differences between the HS or control groups with respect to postoperative drain output (48.7 ± 33.8 mL vs. 48.0 ± 22.9 mL, respectively, P ± 0.05) or facial nerve function. Use of the Harmonic Scalpel for superficial parotidectomy is safe and may result in reduced operative time and blood loss compared with conventional techniques. A safe alternative to cold knife superficial parotidectomy is presented with the potential benefits of reduced operative time and blood loss demonstrated.