Current trends in restorative proctocolectomy - Introduction of an ultrasonically activated scalpel

PURPOSE: We evaluated the usefulness of an ultrasonically activated scalpel (Harmonic Scalpel(R)) for mucosal proctocolectomy and ileal J-pouch-anal anastomosis. METHODS: Seventy-four patients with ulcerative colitis (70 patients) and familial adenomatous polyposis (4 patients) underwent mucosectomy using the Harmonic Scalpel(R) since 1997. We compared the clinical and functional results with those of the monopolar electrocoagulator (forceps coagulation technique, 86 patients with colitis and 7 with polyposis). RESULTS: We performed graduated mucosal proctectomy by using the Harmonic Scalpel(R). The operative time (Harmonic Scalpel(R), 42 minutes vs. forceps coagulation technique, 85 minutes) and blood loss (Harmonic Scalpel(R), 33 ml vs. forceps coagulation technique, 86.8 ml) were significantly reduced by this method. The Harmonic Scalpel(R) enabled restorative proctocolectomy by the synchronous approach within three hours. The functional results and complications were not significantly different between the two groups. CONCLUSION: The Harmonic Scalpel(R) shortened the operative time, decreased blood loss, and was useful for restorative proctocolectomy in our study.