A Prospective Study of Incisional Time, Blood Loss, Pain, and Healing With Carbon Dioxide Laser, Scalpel, and Electrosurgery

Abstract

Carbon dioxide laser incisions are reported to be less painful, less bloody, and less prone to seroma formation and to heal better than scalpel or electrosurgical incisions. We compared all three modalities in a prospective randomized study of cholecystectomy incisions. Time required for the incision and incisional blood loss was less with electrosurgery than with the carbon dioxide laser or scalpel. Postoperative pain and wound healing, however, were the same for all three techniques. The carbon dioxide laser appears to offer no advantage over conventional means of making a standard incision.

Meta-analysis of the Effectiveness of Surgical Scalpel or Diathermy in Making Abdominal Skin Incisions

“…Eleven studies were finally selected for meta-analysis. [11][12][13][14][15][16][17][18][19][20][21] To include maximum possible evidence in this meta-analysis the standards of inclusion were relaxed for some of the publications. One of the trials studied a combination of general surgical incisions along with the abdominal incisions and was included in the meta-analysis because of its methodology.…”

“…12,17 Another concern with some of the trials was exclusion of patients suffering from diabetes mellitus, coagulation disorders and those taking steroids and anticoagulants. 14,19,20 The results of these individual trials could have been different in the absence of these restrictions. Despite these variations in the methodology, their findings were validated by the current analysis suggesting an equivalent rate of wound infection with either way of making skin incisions.…”

“…In scalpel incisions, hemostasis was attained with the help of coagulation diathermy, 13,19,20 whereas diathermy incisions were initiated with cold scalpel usually up to the level of reticular dermis. [13][14][15][16][17][18] Diathermy, when used in isolation was engaged either in cutting mode or a combination of cutting and coagulation mode. 12,19,20,21 It was evident that the actual time taken for scalpel incisions could have been shorter at the cost of greater blood loss if no diathermy was to be used.…”

Midline or transverse abdominal incision for right‐sided colon cancer—a randomized trial

“…A number of reports have been published in the past evaluating types of incision and their influence on the post‐operative course. Thus, while some authors claim that the transverse incision is associated with less pain, improved post‐operative respiratory function and a lower incidence of complications, other studies fail to confirm these advantages [1–6].…”

Electrosurgery, Electrocoagulation, Electrofulguration, Electrodesiccation, Electrosection, Electrocautery

“…No statistically significant difference was observed in the degree of postoperative pain, the number of wound seromas/infections, and wound healing. 19 It is of interest, however, that animal studies consistently demonstrate slower wound healing with electrosection compared to scalpel surgery. 20,21 Another RCT compared electrosection to scalpel surgery in 84 patients undergoing inguinal herniorrhaphy or cholecystectomy in terms of incisional time, cosmetic outcome, postoperative pain, and wound complications.…”