Skip to main content Accessibility help

New generation cut-and-seal devices in oral and oropharyngeal cancer resection: clinical and cost-effectiveness study

  • G Tirelli (a1), G C Del Piero (a1), G Valentinuz (a2), A Monte (a2), A Gatto (a1), A Rebelli (a3) and E Quatela (a1)...



To evaluate the clinical efficacy and cost-effectiveness of ultrasonic shears and the electrothermal bipolar vessel sealing system, in comparison to the traditional cold knife and bipolar forceps, in oral and oropharyngeal cancer surgery.


Patients who underwent oral or oropharyngeal cancer resection and neck dissection with either ultrasonic shears (n = 36) or electrothermal bipolar vessel sealing (n = 32) were enrolled. Surgical time, intra-operative bleeding, blood drainage, post-operative pain, neck oedema, complications and hospitalisation duration were compared to those of an historical cohort of 36 patients treated using a cold knife and bipolar forceps. Additionally, a cost-effectiveness evaluation was performed.


Ultrasonic shears and, in particular, electrothermal bipolar vessel sealing, were advantageous compared to the traditional techniques. The cost of ultrasonic shears and electrothermal bipolar vessel sealing was completely offset by declining time-driven costs for the surgical team and operating theatre.


Ultrasonic shears and, in particular, electrothermal bipolar vessel sealing, are more advantageous compared to the traditional techniques, from both a clinical and economic point of view.


Corresponding author

Address for correspondence: Dr Eliana Quatela, ENT Department, Cattinara Hospital, Strada di Fiume, 447, 34149 Trieste, Italy Fax: 00 39 0403 994 180 E-mail:


Hide All
1Jackson, LL, Gourin, CG, Thomas, DS, Porubsky, ES, Klippert, FN, Terris, DJ. Use of the harmonic scalpel in superficial and total parotidectomy for benign and malignant disease. Laryngoscope 2005;115:1070–3
2Chang, LY, O'Neill, C, Suliburk, J, Sidhu, S, Delbridge, L, Sywak, M. Sutureless total thyroidectomy: a safe and cost-effective alternative. ANZ J Surg 2011;81:510–14
3da Silva, FB, Limoeiro, AC, Del Bianco, J, Teich, V, Teich, N, Teixeira, JC et al. Impact of the use of vessel sealing or harmonic scalpel on intra-hospital outcomes and the cost of thyroidectomy procedures. Einstein (Sao Paulo) 2012;10:354–9
4Lombardi, CP, Raffaelli, M, Cicchetti, A, Marchetti, M, De Crea, C, Di Bidino, R et al. The use of ‘harmonic scalpel’ versus ‘knot tying’ for conventional ‘open’ thyroidectomy: results of a prospective randomized study. Langenbecks Arch Surg 2008;393:627–31
5Manouras, A, Markogiannakis, H, Koutras, AS, Antonakis, PT, Drimousis, P, Lagoudianakis, EE et al. Thyroid surgery: comparison between the electrothermal bipolar vessel sealing system, harmonic scalpel, and classic suture ligation. Am J Surg 2008;195:4852
6Youssef, T, Mahdy, T, Farid, M, Latif, AA. Thyroid surgery: use of the LigaSure Vessel Sealing System versus conventional knot tying. Int J Surg 2008;6:323–7
7Koh, YW, Park, JH, Lee, SW, Choi, EC. The harmonic scalpel technique without supplementary ligation in total thyroidectomy with central neck dissection: a prospective randomized study. Ann Surg 2008;247:945–9
8Salami, A, Dellepiane, M, Bavazzano, M, Crippa, B, Mora, F, Mora, R. New trends in head and neck surgery: a prospective evaluation of the Harmonic Scalpel. Med Sci Monit 2008;14:PI1–5
9Kiriakopoulos, A, Tsakayannis, D, Linos, D. Use of a diathermy system in thyroid surgery. Arch Surg 2004;139:9971000
10Kaplan, RS, Witkowski, ML. Better accounting transforms health care delivery. Accounting Horizons 2014;28:365–83
11Porter, ME, Teisberg, E. Redefining Healthcare: Creating Value-Based Competition on Results. Boston: Harvard Business Press, 2006
12Porter, ME, Lee, T. The strategy that will fix health care. Harv Bus Rev 2013;10:219
13Macario, A. What does one minute of operating room time cost? J Clin Anesth 2010;22:233–6
14Kaplan, R, Anderson, S. Time-driven activity-based costing. Harv Bus Rev 2004;82:131–8
15Salami, A, Bavazzano, M, Mora, R, Dellepiane, M. Harmonic Scalpel in pharyngolaryngectomy with radical neck dissection. J Otolaryngol Head Neck Surg 2008;37:633–7
16Pons, Y, Gauthier, J, Clèment, P, Conessa, C. Ultrasonic partial glossectomy. Head Neck Oncol 2009;1:21
17Tirelli, G, Del Piero, GC, Perrino, F. Ultracision Harmonic Scalpel in oral and oropharyngeal cancer resection. J Craniomaxillofac Surg 2014;42:544–7
18Dilek, ON, Yilmaz, S, Degirmenci, B, Ali Sahin, D, Akbulut, G, Dilek, FH. The use of a vessel sealing system in thyroid surgery. Acta Chir Belg 2005;105:369–72
19Sartori, PV, De Fina, S, Colombo, G, Pugliese, F, Romano, F, Cesana, G. Ligasure versus Ultracision in thyroid surgery: a prospective randomized study. Langenbecks Arch Surg 2008;393:655–8
20McNally, MM, Agle, SC, Williams, RF, Pofahl, WE. A comparison of two methods of hemostasis in thyroidectomy. Am Surg 2009;75:1073–6
21Harold, KL, Pollinger, H, Matthews, BD, Kercher, KW, Sing, RF, Heniford, BT. Comparison of ultrasonic energy, bipolar thermal energy, and vascular clips for the hemostasis of small-, medium-, and large-sized arteries. Surg Endosc 2003;17:1228–30
22Dubuc-Lissoir, J. Use of a new energy-based vessel ligation device during laparoscopic gynecologic oncologic surgery. Surg Endosc 2003;17:466–8
23Fakhry, N, Michel, J, Santini, L, Lagier, A, Turner, F, Dessi, P et al. Utility of the LigaSure vessel sealing system during major head and neck cancer surgery. J Laryngol Otol 2012;126:815–17
24Prokopakis, EP, Lachanas, VA, Vardouniotis, AS, Velegrakis, GA. The use of the Ligasure vessel sealing system in head and neck surgery: a report on six years of experience and a review of the literature. B-ENT 2010;6:1925
25Walen, SG, Rudmik, LR, Dixon, E, Matthews, TW, Nakoneshny, SC, Dort, JC. The utility of the harmonic scalpel in selective neck dissection: a prospective, randomized trial. Otolaryngol Head Neck Surg 2011;144:894–9
26Zarebczan, B, Mohanty, D, Chen, H. A comparison of the LigaSure and harmonic scalpel in thyroid surgery: a single institution review. Ann Surg Oncol 2011;18:214–18
27Sutton, PA, Awad, S, Perkins, AC, Lobo, DN. Comparison of lateral thermal spread using monopolar and bipolar diathermy, the Harmonic Scalpel and the Ligasure. Br J Surg 2010;97:428–33
28Tirelli, G, Camilot, D, Bonini, P, Del Piero, GC, Biasotto, M, Quatela, E. Harmonic Scalpel and Electrothermal Bipolar Vessel Sealing System in head and neck surgery: a prospective study on tissue heating and histological damage on nerves. Ann Otol Rhinol Laryngol 2015;124:852–8
29Sebag, F, Fortainer, C, Ippolito, G, Lagier, A, Auquier, P, Henry, JF. Harmonic scalpel in multinodular goiter surgery: impact on surgery and cost analysis. J Laparoendosc Adv Surg Tech A 2009;19:171–4
30Dibidino, R, Ruggeri, M, Marchetti, M, Lombardi, N, Raffaelli, M, Attinà, G et al. The harmonic study: cost-effectiveness evaluation of the use of the ultrasonic scalpel in total thyroidectomy. Int J Technol Assess Health Care 2012;28:259–64
31Petrakis, IE, Kogerakis, NE, Lasithiotakis, KG, Vrachassotakis, N, Chalkiadakis, GE. LigaSure versus clamp-and-tie thyroidectomy for benign nodular disease. Head Neck 2004;26:903–9
32Hallgrimsson, A, Lovén, L, Westerdahl, J, Bergenfelz, A. Use of the harmonic scalpel versus conventional haemostatic techniques in patients with Grave disease undergoing total thyroidectomy: a prospective randomised controlled trial. Langenbecks Arch Surg 2008;393:675–80
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
  • URL: /core/journals/journal-of-laryngology-and-otology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed