***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Abstract . Surgical treatment is considered to be the best therapeutic modality for severe hemorrhoidal disease . Different surgical methods of hemorrhoidectomy aim to decrease pain , bleeding , stenosis and discharge . The aim of this study was to evaluate the efficacy of harmonic scalpel hemorrhoidectomy . During a period of seven months , 54 consecutive patients with third- and fourth-degree hemorrhods were prospect ively r and omized for harmonic scalpel hemorrhoidectomy ( HS ) or Milligan-Morgan procedure ( MM ) . These patients were examined at one , two , and six weeks after the operation . All patients had a lower gastrointestinal investigation prior to operation to exclude other colorectal pathologies . All patients had the same kind of preoperative preparation and analgesia during the postoperative course . Pain was assessed using a visual analog scale from 0 to 10 . Patient satisfaction was defined as decrease or absence of symptoms and return to normal daily activities . HS groups included 29 patients , while the MM  group had 25 patients . There as no difference between the groups in terms of age , gender , hemorrhoidal degree and indication for operation . The types of intra-operative anesthesia administered to the two groups were similar . Duration of surgery was significantly higher in the MM group ( p<0.0001 ) . Postoperative hospitalization was longer in the MM group ( p<0.0001 ) , and the pain degree was higher in MM group ( p<0.0001 ) . No significant difference was noted in the overall amount of analgesics used in the two groups at week 1 , although it was significantly higher in the MM group 2 and 3 weeks after the operation . Early complication occurred more frequently in the MM group but overall the difference was not statistically significant . In conclusion , harmonic scalpel hemorrhoidectomy is virtually a bloodless operation with minimal tissue damage . It is associated with significant less postoperative pain and a fast return to normal activity Ultrasonically activated coagulating shears ( CS ) can coagulate and divide blood vessels of up to medium size by a tissue-welding technique . We present an application of CS in hepatic parenchymal transection during liver surgery . Intrahepatic vessels are uncovered by the so-called forceps fracture method , and they are coagulated and divided by CS . Larger vessels are tied only on the preserving side before the application of CS . Although further refinement of the CS tip is needed , this method has the potential to significantly simplify and improve surgical procedures for hepatic parenchymal transection PURPOSE A r and omized trial was undertaken to evaluate and compare stapled hemorrhoidopexy with excisional hemorrhoidectomy in which the Harmonic Scalpel ™ was used . METHODS Patients with Grade III hemorrhoids who were employed during the trial period were recruited and r and omized into two groups : ( 1 ) Harmonic Scalpel ™ hemorrhoidectomy , and ( 2 ) stapled hemorrhoidopexy . All operations were performed by a single surgeon . In the stapled group , the doughnut obtained was sent for histopathologic examination to determine whether smooth muscles were included in the specimen . Operative data and complications were recorded , and patients were followed up through a structured pro forma protocol . An independent assessor was assigned to obtain postoperative pain scores and satisfaction scores at six-month follow-up . Patients were also administered a simple question naire at follow-up to assess continence functions . RESULTS Over a 20-month period , 88 patients were recruited . The two groups were matched for age and gender distribution . No significant difference was identified between the two groups in terms of operation time , blood loss , day of first bowel movement after surgery , and complication rates . Despite a similar parenteral and oral analgesic requirement , the stapled group had a significantly better pain score ( P = 0.002 ) ; these patients also had a significantly shorter length of stay ( P = 0.02 ) , and on average resumed work nine days earlier than the group treated with the Harmonic Scalpel ™ ( 6.7 vs. 15.6 , P = 0.002 ) . Although 88 percent of doughnuts obtained in the stapled group contained some smooth muscle fibers , no association was found between smooth muscle incorporation and postoperative continence function , and as a whole the continence outcomes of the stapled group were similar to those after Harmonic Scalpel ™ hemorrhoidectomy . Finally , at six-month follow-up , patients who underwent the stapled procedure had significantly better satisfaction scores ( P = 0.001 ) . CONCLUSIONS tapled hemorrhoidopexy is a safe and effective procedure for Grade III hemorrhoidal disease . Patients derive greater short-term benefits of reduced pain , shorter length of stay , and earlier resumption to work . Long-term follow-up is necessary to determine whether these initial results are lasting BACKGROUND We used an ultrasonic scalpel ( USS ) and an argon beam coagulator ( ABC ) to test their effectiveness and feasibility in comparison to conventional electrocautery for Internal Thoracic Artery ( ITA ) takedown , time for takedown , number of clips , thermal impact , along with morphological integrity assessed by histology . PATIENTS AND METHODS Ninety-three patients undergoing elective coronary bypass surgery were prospect ively r and omized into three groups . In thirty-one patients , either an ultrasonic scalpel ( USS , group A ) , an argon-beam coagulator ( ABC , group B ) or conventional electrocautery ( CEC , group C ) was used for ITA harvesting . RESULTS Harvest times for ITA takedown using CEC ( 16.7 + /- 6 min ) was significantly faster compared to ABC ( 21.6 + /- 8.1 min ; p = 0.02 ) and USS ( 24.1 + /- 8.1 min ; p < 0.001 ) . There was no significant difference comparing harvest times of USS and ABC ( p = 0.1 ) . The number of hemostatic clips used was significantly lower when using USS ( 5.5 + /- 4.6 clips ) compared to both CEC ( 16.6 + /- 6.2 clips ; p < 0.001 ) and ABC ( 20.4 + /- 6.5 clips ; p < 0.001 ) and significantly lower using CEC compared to ABC ( p < 0.007 ) . There were no significant differences in bleeding points within the tissue bed among the groups ( ABC 11/31 patients , CEC 11/31 patients and USS 12/31 patients ) . CONCLUSION This study demonstrates that dissection of the ITA pedicle can be safely done with USS , ABC , and CEC . However , USS is associated with less hemostatic clip dem and but prolonged harvest time compared it to ABC and CEC ; histological assessment revealed no significant difference when comparing groups and equipment used . A variety in design of the hooks may probably ease ultracision practicability Laparoscopic  cholecystectomy  is frequently complicated by gallbladder perforation and loss of bile or stones into the peritoneal cavity . The aim of this study was to compare the use of ultrasonic dissection and electrocautery with respect to the incidence of gallbladder perforation and intraoperative consequences Ultrasonic energy has recently been used for surgical cutting and coagulating . A prospect i ve r and omized study was undertaken to determine the effectiveness of ultrasonic energy versus monopolar electrosurgery in human laparoscopic cholecystectomy . Two hundred patients were enrolled and r and omized into two groups of 100 patients each . Group A patients underwent laparoscopic cholecystectomy with monopolar electrocautery .  Group B patients underwent laparoscopic cholecystectomy with ultrasonically activated shears . In 18 cases of this group , the cystic artery was coagulated and cut without clips . Subhepatic closed drainage was left for 24 h in patients who were c and i date s for oozing of blood or leakage of bile . The median operating time was 45 min in group A and 37 min in group B. Subhepatic drainage was left in 37 patients of group A and 26 of group B. The median blood loss was 14 ml in group A and 2 ml in group B , while 3 patients of group A and none of group B had bile leakage from the bed of the gallbladder for 1 , 1 , and 6 days , respectively . Postoperative ultrasound examination showed a minor subhepatic fluid collection in 5 patients of group A and in 1 patient of group B. All these collection s were treated without drainage . The length of hospital stay was 1.9 + /- 0.5 days in group A and 1.4 + /- 0.2 days in group B. Postoperative pain scores , nausea , and vomiting were equivalent in both groups . It is concluded that ultrasonically activated coagulating shears are safer , easier to use , faster , and less prone to intraoperative complications and postoperative morbidity than monopolar electrocautery in laparoscopic cholecystectomy Division of the short gastric vessels ( SGV ) is a st and ard component of laparoscopic Nissen fundoplications ( LNF ) at our institution . This study compares our original method of vessel control , multifire clip applier ( MCA ) and sharp division , to the Ultracision Harmonic Scalpel LCS ( LCS ) .  Twenty consecutive patients were evaluated in a r and omized prospect i ve fashion . Times for SGV division and estimated blood loss ( EBL ) were recorded . Cost data represent patient charges for use of either the MCA or LCS and the charge for operative time . Use of the LCS produced a significant reduction in the time required for SGV division and in the charges to the patient Background : Conventionally , the pectoralis major myocutaneous flap is raised using electrocautery and /or other sharp instruments . The reported morbidity rate using conventional techniques of flap dissection varies from 16 to 63 percent . The purpose of this study was to consider the feasibility of myocutaneous flap dissection using the harmonic scalpel and to compare operative time , blood loss , drainage volume , and morbidity between patients undergoing flap dissection with the harmonic scalpel  and those being treated with electrocautery .  Methods : Thirty patients with oral cancer , for whom resection and reconstruction using a pectoralis major myocutaneous flap was planned , were recruited in a prospect i ve , r and omized two-arm trial . Patients in arm I ( n = 15 ) had flap dissection using electrocautery and patients in arm II ( n = 15 ) had flap dissection using the harmonic scalpel . Results : The mean operative duration for flap dissection ( 84 versus 47 minutes ) , blood loss ( 129 versus 36 ml ) , and total drainage volume ( 551 versus 302 ml ) were found to be significantly less in the harmonic scalpel group . Conclusion : The results of the study indicate that it is feasible to dissect pectoralis major myocutaneous flaps using the harmonic scalpel with less operative time , blood loss , drainage volume , and morbidity in comparison with electrocautery OBJECTIVE To compare the safety and effectiveness of laparosonic coagulating shears ( LCS ) and electrosurgery for use in laparoscopically assisted vaginal hysterectomy ( LAVH ) . STUDY DESIGN In this prospect i ve study , patients undergoing LAVH performed by one of the authors from October 1997 to January 1998 were assigned at r and om to the electrosurgery group ( n = 20 ) or the LCS group ( n = 20 ) . Procedures performed with LCS or electrosurgery included coagulation and separation of infundibulopelvic or utero-ovarian round ligaments , vesico-uterine-visceral peritoneal fold dissection , and anterior and posterior colpotomy . Outcome measures were operative time , blood loss , decrease in hemoglobin values , and length of hospitalization . RESULTS The mean operative time ( 90+/-22.9 min versus 80.3+/-17.1 min , P = 0.391 ) , blood loss ( 308+/-167 ml versus 250+/-104 ml , P = 0.11 ) , and hemoglobin decrease ( 1.57+/-0.769 mg/dl versus 1.36+/-0.886 mg/dl , P = 0.55 ) were slightly greater in the LCS group than in the electrosurgery group , although these differences were not statistically significant . The length of hospital stay was similar in the two groups ( 5 days ) . No patients developed serious complications related to electrosurgery or LCS . CONCLUSION Our findings indicate that LCS is as safe and effective as electrosurgery , and may offer an alternative option for patients undergoing LAVH Abstract Background : Division of the short gastric vessels ( SGV ) during laparoscopic Nissen fundoplication ( LNF ) may improve outcome . Several techniques are available for SGV division . The aim of this study was to compare in a prospect i ve r and omized trial bipolar electrocautery with cutting blade versus ultrasonic coagulation of the SGV during LNF . Methods : In all , 86 consecutive patients undergoing LNF were prospect ively r and omized into two similar groups that underwent division of the SGV , respectively , using bipolar cutting forceps ( BPCF ) or harmonic coagulating shears ( HCS ) .  Operative time , bleeding episodes , complications , equipment problems , and surgeon 's subjective scoring of satisfaction and ease of use were assessed . Results : Mean ( ±SD ) time for fundic mobilization and division of the SGV was not significantly different between the two groups ( BPCF = 20 ± 12 min vs. HCS = 22 ± 12 min ) . Bleeding events , estimated blood loss , surgeon satisfaction , and subjective ease of use were similar , and no transf 
    Output:
    
Meta- analysis of outcomes comparing ultrasonic with conventional nonultrasonic surgical instrumentation demonstrates significant improvement of several perioperative outcomes in procedure-specific setting s when ultrasonic instrumentation is used