Parotidectomy using the Harmonic scalpel: ten years of experience at a rural academic health center

Background: Parotidectomy is one of the most commonly performed procedures by otorhinolaryngologists. Traditionally dissection is performed with a combination of a steel scalpel and bipolar cautery; however, starting in the early 2000s, the Harmonic scalpel has provided an alternative method for dissection and hemostasis. The purpose of this study is to compare operative time, blood loss, complications, and cost between the Harmonic scalpel and steel scalpel plus bipolar cautery for superficial and total parotidectomy. Methods: Retrospective cohort of patients who underwent superficial or total parotidectomy with the Harmonic or cold steel between 2000 and 2015. Across 255 patients, comparison between operative time, blood loss, complications, and cost was performed. Results: Superficial parotidectomy was performed on 120 patients with the Harmonic and 54 with steel scalpel. Total parotidectomy was performed on 59 patients using the Harmonic and 22 patients with cold steel. For superficial parotidectomy, the Harmonic reduced operative time (216 +/- 42 vs. 234 +/- 54 min, p = 0.03) and decreased blood loss (28 +/- 19 vs. 76 +/- 52 mls, p \u3c 0.05). With total parotidectomy the Harmonic decreased operative time (240 +/- 42 vs. 288 +/- 78 min, p = 0.01) and reduced blood loss (38 +/- 21 mls vs. 85 +/- 55 mls, p \u3c 0.05). There were no differences in complication rates between groups. Harmonic use was associated with surgical cost reduction secondary to reduced operative times. Conclusions: The Harmonic scalpel decreases blood loss and operating time for superficial and total parotidectomy. Shorter operative times may decrease the overall cost of parotidectomy