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Monopolar electrocautery versus sharp dissection in the neck dissection: a retrospective study.

Katharina Theresa Obermeier1, Paris Liokatis2, Wenko Smolka2

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Monopolar electrocautery (ME) significantly reduces blood loss and surgery time in neck dissections compared to cold scalpel/scissors (CS). This finding holds true for both radial forearm free flap and primary closure techniques in head and neck oncology.

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Area of Science:

  • Oncology
  • Surgical Oncology
  • Head and Neck Surgery

Background:

  • Cold scalpel/scissors (CS) and monopolar electrocautery (ME) are standard instruments for neck dissection in head and neck oncology.
  • A direct comparative analysis of these techniques regarding surgical outcomes is lacking.

Purpose of the Study:

  • To compare the efficacy of ME versus CS in neck dissection.
  • To evaluate differences in intraoperative blood loss, hemoglobin decline, and surgery duration between ME and CS.

Main Methods:

  • Retrospective analysis of data from 200 patients undergoing tumor resection and neck dissection.
  • Patients were categorized based on defect closure (radial forearm free flap or primary closure) and the primary instrument used for neck dissection (ME or CS).
  • Comparison of intraoperative blood loss, hemoglobin level decrease, and surgery duration across the defined groups.

Main Results:

  • Patients undergoing neck dissection with ME exhibited significantly less blood loss (409.93 ml and 242.4 ml less in respective comparisons) compared to CS.
  • The median decrease in hemoglobin levels was lower with ME (1.01 g/dL and 0.85 g/dL lower in respective comparisons).
  • Median surgery duration was substantially shorter when using ME (102 min and 83 min shorter in respective comparisons).

Conclusions:

  • Monopolar electrocautery is a more efficient instrument for neck dissection than cold scalpel/scissors.
  • ME use in neck dissection leads to statistically significant reductions in blood loss, hemoglobin decline, and operative time.
  • These findings suggest ME as a preferred method for optimizing surgical outcomes in head and neck cancer surgery.