The use of bipolar pure cut mode technology in dissection of parotid tumors: A novel technique

Abstract

Background The basic concern in parotid surgery is facial nerve preservation. Various methods of dissection have been used to excise the parotid tissue and spare the facial nerve and its branches. Combined (blunt, mosquito tip, monopolar, and bipolar electrocautery, and scissor dissection) procedures are the most widely used techniques. Further new methods were used as an alternative for hemostasis and dissection such as ligasure and ultrasonic devices. New emerging technology of bipolar energy with high voltage and low current gave a benefit of deep coagulation and powerful cutting with less spread of heat to the surrounding tissue. In this study, we tried a new dissection technique with the pure auto-cut bipolar electrodissection with the new versions of bipolar technology to report its effect in parotid tumor surgery. The primary objective of the study was to evaluate the safety and efficacy of new bipolar pure cut electrodissection and weighing its benefits in the preservation of the facial nerve branches and reducing the postoperative complications. The secondary objective of the study was to compare the result of the new technique with the results of the conventional technique that was previously performed in our department and the complication of this new technique if any. Patients and methods This prospective and retrospective study was held in Menoufia University Hospital. Our study included 30 patients with parotid tumors, where 15 retrospective patients underwent conventional parotidectomy (superficial and/or total parotidectomy) and were referred as group B, and 15 prospective patients underwent parotidectomy (superficial or total parotidectomy) and were referred as group A, using the bipolar pure auto-cut electrodissection technique by advanced bipolar technology. Results The mean operative time was significantly lower in group A patients than in group B, where the time for superficial parotidectomy was 100±14 min in group A and 117±11 min in group B and for total parotidectomy was 118±12 min in group A and 139±18 min in group B (P=0.001). Regarding postoperative complications, in group A, we reported one case with temporary nerve affection. However, in group B, we reported two cases of wound infection, one case with salivary fistula, two cases with seroma, two cases of temporary nerve affection, two cases of permanent nerve branch affection, and one case of Frey syndrome. Regarding tumor recurrence, we reported only one case in group B. Conclusions Using the new bipolar pure cut technique in various types of parotid tumors is technically easier for meticulous fast dissection around the facial nerve branches, showing significantly shorter operative time and less incidence of seroma, wound infection, salivary fistula, and facial nerve injury.