Harmonic Scalpel

The harmonic scalpel represents one of the most innovative instruments introduced in the last decade, and is the only one that can practically combine dissection and hemostasis functions. The harmonic scalpel uses ultrasonic energy and eliminates the passage of electrical energy through the patient, like in conventional electrosurgery. The harmonic scalpel cuts and coagulates the tissue at temperature lower than 100°C. Cutting speed and coagulation are inversely related. More power results in increased distance traveled by the blade. Some devices are available with several power levels varying from a range of 50 to approximately 100 |tm, which overall provide efficacious compromise between hemostasis and dissection in virtually any tissue encountered during surgery. The lower temperature and more controllable energy form result in smaller lateral thermal tissue damage.

Despite its characteristics, the harmonic scalpel has not found a consistent application in living-donor hep-atectomy. One possible explanation might be that some investigators have not found any advantage in terms of transection speed, decreased blood loss, and decreased complications incidence when comparing the harmonic scalpel with the traditional crush clamp technique or the ultrasonic and water-jet dissectors [30, 31].

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