A case-controlled study comparing harmonic versus electrosurgery in laparoscopic myomectomy.

OBJECTIVE

To compare the safety and effectiveness of the harmonic scalpel and conventional electrosurgery in laparoscopic myomectomy (LM).

MATERIALS AND METHODS

We performed a retrospective chart review of 591 women with symptomatic uterine fibroids who underwent LM. Thirty-three cases of LMs with harmonic scalpel (LMH) were compared with a matched control group that underwent conventional electrosurgery (LME). Outcome measures for both groups were studied comparatively in terms of the amount of blood loss, requirement of blood transfusion, length of operative time, cost, and hospital stay.

RESULTS

There was no incidence of switching to abdominal laparotomy. Length of postoperative stay was significantly lower in the LMH group than in the LME group (2.0±0.4 days vs. 2.5±0.7 days, p<0.001), but the hospital charges were significantly higher in the LMH group than in the LME group (39,207.7±9315.0 new Taiwan dollar vs. 24,078.4±11,051.3 new Taiwan dollar, p<0.001). Four minor complications were noted in the LME group; two developed lower-grade febrile morbidity, one had urinary tract infection, and one had subcutaneous ecchymosis at the left ancillary port site. Length of operation, blood loss, hemoglobin decrease, and requirement of blood transfusion were not significantly different between the two groups.

CONCLUSION

Harmonic scalpel is as safe and effective as conventional electrosurgery, and may offer an alternative option for patients undergoing LM. Harmonic scalpel has advantage over conventional electrosurgery in less postoperative hospital stay but disadvantage in higher cost.