The safety and efficacy of the ultrasonic scalpel (Harmonic Scalpel; Ethicon Endo-Surgery, Cincinnati, OH) for carotid endarterectomy (CEA) were evaluated.
Material and Methods: CEA was performed in 28 consecutive patients (27 men, 1 woman; mean age, 72 years) using the ultrasonic scalpel from April 2011 to October 2012. Eighteen cases involved high-position stenosis. Mean percentage stenosis was 78%. Complications were compared to those in 27 consecutive cases treated without the ultrasonic scalpel, performed prior to March 2011.
Results: One patient treated using the ultrasonic scalpel suffered ischemic complication (not significant). No patient using the ultrasonic scalpel died (not significant). Five patients treated using the ultrasonic scalpel showed increased signal hyperintensity on postoperative diffusion-weighted magnetic resonance imaging (not significant). Four patients treated using the ultrasonic scalpel suffered transient hoarseness, including 1 patient with recurrent nerve paralysis (not significant). However, only 3 of the 18 patients treated using the ultrasonic scalpel with high-position stenosis suffered transient hoarseness, showing a significant decrease compared to the 6 of 11 patients with high-position stenosis treated without the ultrasonic scalpel (P<0.05).
Discussion: The ultrasonic scalpel reportedly causes less heat injury to vessels than electrocautery, which may account for the reduced number of complications caused by temporary damage to the superior laryngeal nerve.
Conclusion: The ultrasonic scalpel is a useful tool for CEA, particularly for high-position stenosis.
