Experimental and clinical evaluation of the harmonic scalpel in thoracic surgery.

The Harmonic Scalpel is an ultrasonic instrument for cutting and coagulating tissue. We are reporting our evaluation of the Harmonic Scalpel safety and efficacy in both experimental and clinical thoracic surgery. First, we confirmed the safety in thoracic surgery by following two preliminary studies using the Harmonic Scalpel. 1: Pulmonary parenchyma was incised using "Coagulating Shears" to evaluate hemostasis and air leakage. 2: Pulmonary hilar vessels were contacted directly with "Dissecting Hook" blade at optimum cutting power mode to evaluate potential vascular wall injury by the Harmonic Scalpel. Subsequently, the Harmonic Scalpel was used for a partial lung resection due to metastatic lung cancer. Particular application was for a chest wall incision, interlobar separation of the lung, and dissection of a pulmonary artery, in lung cancer operations. We concluded that cutting and hemostasis of pulmonary parenchyma could be achieved with minimal tissue damage using the Harmonic Scalpel. Compared to electric coagulation, the Harmonic Scalpel minimizes tissue charring and dissection, and eliminates thermal injury in thoracic surgery.