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 a nastomosis. METHODS: Seventy-four patients with ulcerative colitis (70 pati ents) and familial adenomatous polyposis (4 patients) underwent mucosectomy using the Harmonic Scalpel(R) since 1997. We compared the clinical and fun ctional results with those of the monopolar electrocoagulator (forceps coag ulation 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 coagulat ion technique, 85 minutes) and blood loss (Harmonic Scalpel(R), 33 ml vs. f orceps coagulation technique, 86.8 ml) were significantly reduced by this m ethod. The Harmonic Scalpel(R) enabled restorative proctocolectomy by the s ynchronous approach within three hours. The functional results and complica tions 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.