In an effort to elucidate whether the Harmonic Scalpel will improve sealing lymphatics and
decrease lymphatic drainage thereby decreasing the length of time that chest tubes are
required and minimizing length of stay; the Harmonic Scalpel will be compared to a control
group which uses electrocautery. This study will assess these two different methods to
determine if there is a notable decrease in the amount of drainage with one versus the
Lymph node dissection is an integral part of the surgical management of lung cancer.
Knowledge of lymph node status plays a key role in therapeutic decision making and
prognosis. Associated with this dissection comes the propensity for lymphatic leakage,
increased chest tube drainage, prolonged retention of chest tubes in the postoperative
period and increased patient length of stay. Our center performs complete mediastinal node
dissection of all relevant regional lymph nodes which generally include paratracheal,
pretracheal, subcarinal, hilar and paraesophageal nodes. The current standard of practice
for the dissection of the lymph nodes includes the use of the Harmonic Scalpel or
electrocautery. Known risk of electrocautery include localized nerve damage, cardiac
arrhythmias and damage to the tissue sample/specimen that is used for pathology. The
Harmonic Scalpel technology has recently become available for use. Current experience with
the Harmonic Scalpel suggests that there is less localized nerve damage, less incidence of
arrhythmias, less damage to the tissue sample and less lymph leakage. There is no published
data to support this hypothesis, thus the purpose of this study.
- Patients undergoing resection for stage 1, 2 or 3A lung cancer.
- Patients between the ages of 20-75.
- History of Congestive Heart Failure.
- History of renal failure, ie., creatinine greater than 2.2.
- Patients with bulky or matted lymph nodes in stage 3A.
- Current pregnancy.
- Current participation in another study involving an investigational device or drug.
Joseph Newton, MD
Sentara Cardiovascular Research Institute
Laura Pine, RN, BSN