The Effect of Ultrasonic Vibrating Scalpel (Harmonic Scalpel) on Wound Healing of Intestinal Anastomosis

Kosei Maemura, Sonshin Takao, Kouki Tokuda, Keiichirou Uchikura, Kenji Kihara, Masaaki Kubo, Saburou Nakashima, Masayuki Yanagi, Hiroyuki Shinchi and Takashi Aikou

First Department of Surgery, Kagoshima University School of Medicine

An ultrasonically vibrating scalpel (harmonic scalpel) has been developed for producing surgical incisions with reduced hemorrhage, and has been applied clinically in both endoscopic and open surgical procedures. Although a number of studies have supported its use in endoscopic surgery, few studies have addressed the applicability of this device to open gastrointestinal operations. The aim of this study was to determine the effect of a harmonic scalpel on tissue injury and wound healing after division and re-anastomosis of a small bowel segment, and to compare these findings to those obtained with a standard surgical scalpel and with electrocautery. Twelve beagles were used for this study. In each animal, a segment of small intestine was divided in three separate places, using each of the three scalpel devices. After division and re-anastomosis were performed, blood loss from each location was measured. Also tissue injury and wound healing of each anastomotic site were assessed by microangiography and histopathology on the 1st, 3rd, 5th, 7th, 14th and 21st postoperative days. These findings showed that sites divided with the harmonic scalpel had significantly less blood loss. Although harmonic scalpel showed higher avascular area occupied ratio than regular scalpel, no significant difference in neovascular vessels occupied ratio was observed. Histologic examination revealed that segments divided with the harmonic scalpel retained more normal tinnue architecture at the site of anastomosis 14 days after the operation. Our results indicate that use of the harmonic scalpel allows faster wound healing than with electrocautery, and is an effective alternative for intestinal anastomosis.

Key words
ultrasonic scalpel, intestinal anastomosis, tissue injury, wound healing, microangiography

Reprint requests
Kosei Maemura First Department of Surgery, Kagoshima University School of Medicine, 8-35-1 Sakuragaoka, Kagoshima, 890-8520 JAPAN

Accepted
October 26, 1999

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