***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: The development of operative laparoscopic surgery is linked to advances in ancillary surgical instrumentation . Ultrasonic energy devices avoid the use of electricity and provide effective control of small to medium-sized vessels . Bipolar computercontrolled electrosurgical technology eliminates the disadvantages of electrical energy , and a mechanical blade adds a cutting action . This instrument can provide effective hemostasis of large vessels up to 7 mm . Such devices significantly increase the cost of laparoscopic procedures , however , and the amount of evidence -based information on this topic is surprisingly scarce . This study compared the effectiveness of three different energy sources on the laparoscopic performance of a left colectomy . The trial included 38 nonselected patients with a disease of the colon requiring an elective segmental left-sided colon resection . Patients were preoperatively r and omized into three groups . Group I had electrosurgery ; vascular dissection was performed entirely with an electrosurgery generator , and vessels were controlled with clips . Group II underwent computer-controlled bipolar electrosurgery ; vascular and mesocolon section was completed by using the 10-mm Ligasure device alone . In group III , 5-mm ultrasonic shears ( Harmonic Scalpel ) were used for bowel dissection , vascular pedicle dissection , and mesocolon transection . The mesenteric vessel pedicle was controlled with an endostapler . Demographics ( age , sex , body mass index , comorbidity , previous surgery and diagnoses requiring surgery ) were recorded , as were surgical details ( operative time , conversion , blood loss ) , additional disposable instruments ( number of trocars , EndoGIA charges , and clip appliers ) , and clinical outcome . Intraoperative economic costs were also evaluated . End points of the trial were operative time and intraoperative blood loss , and an intention-to-treat principle was followed . The three groups were well matched for demographic and pathologic features . Surgical time was significantly longer in patients operated on with conventional electrosurgery vs the Harmonic Scalpel or computed-based bipolar energy devices . This finding correlated with a significant reduction in intraoperative blood loss . Conversion to other endoscopic techniques was more frequent in Group I ; however , conversion to open surgery was similar in all three groups . No intraoperative accident related to the use of the specific device was observed in any group . Immediate outcome was similar in the three groups , without differences in morbidity , mortality , or hospital stay . Analysis of operative costs showed no significant differences between the three groups . High-energy power sources specifically adapted for endoscopic surgery reduce operative time and blood loss and may be considered cost-effective when left colectomy is used as a model Purpose We evaluated the safety and cost-effectiveness of the harmonic scalpel ( HS ) during conventional “ open ” thyroidectomy ( CT ) . Material s and methods Two hundred patients scheduled for conventional total thyroidectomy ( TT ) were included in the study and r and omly assigned to TT with the use of HS ( HS group ) or with knot tying technique ( KT group ) . Results Mean operative time was significantly shorter in the HS group ( P < 0.001 ) , as well as the total operative room occupation time ( P < 0.001 ) . The cost of the disposable material s is significantly higher in the HS group ( 420.1 ± 23.2 vs 137.8 ± 25.3 euros ; P < 0.001 ) . Conversely , drugs , personnel and operative room charges were significantly higher in KT group patients ( P < 0.001 ) . Overall , no significant difference was found between the two groups concerning the charges of the hospitalisation ( P = NS ) . Conclusions HS is a safe alternative to KT , allowing for a significant reduction of operative time without increasing complications rate and overall costs and probably better utilization of health re sources Introduction Thyrotoxicosis is often considered to be the most difficult thyroid operation because of the high vascularisation and the risk of bleeding . The conventional haemostatic technique in thyroidectomy today include knot tying and electrocoagulation . The introduction of the harmonic scalpel ( HS ) has led to further research if the use of the HS has any benefits in thyroid surgery . To our knowledge , no previous study has evaluated the HS dissection technique in a homogenous group of patients with Graves ’ disease undergoing total thyroidectomy . Material s and methods Fifty-one patients ( 39 women and 12 men ) with the pre-operative diagnosis of Graves ’ disease treated at two endocrine centers were r and omised to total thyroidectomy with the use of the HS or with conventional haemostatic techniques .  Results Twenty-seven patients were r and omised to the harmonic group and 24 to the conventional group . The operating time was shorter in the HS group ( median , 121 min ; range , 84–213 min ) compared to the conventional group ( median , 172 min ; range , 66–268 min ; p = 0.011 ) . Conclusion The use of the HS was associated with a significant reduction in operating time compared to the use of the conventional haemostatic techniques in patients with Graves ’ disease undergoing total thyroidectomy Introduction Thyroidectomy is among the most commonly performed procedures involving the endocrine gl and s and the development of advanced surgical methods combined with a strife for performing the operation in a manner that is minimally invasive for the patient has considerably increased the need for instruments that would limit surgical trauma . Aim To compare of the outcomes of total thyroidectomy operations with and without the use of ultrasonic harmonic FOCUS dissecting shears . Material and methods Eighty-two patients with a bilateral , non-toxic multinodular goiter were r and omized to two groups of 41 patients each .  Total thyroidectomy was performed in each patient . In the clip-ligation group ( CL-G ) , during thyroidectomy , the superior thyroid vessels were clipped and bipolar coagulation was used to secure smaller vessels , whereas in the harmonic FOCUS group ( HF-G ) , a harmonic device was used to dissect and divide all the thyroid vessels . The statistical analysis included the mean operative time , blood loss , postoperative morbidity and cost-effectiveness . Results HF-G vs. CL-G operations were shorter ( 45.4 ±8.7 min vs. 64.5 ±14.2 min ; p < 0.001 ) , characterized by a lower mean blood loss ( 29.9 ±9.8 ml vs. 56.8 ±11.0 ml ; p < 0.001 ) and appeared to be more cost-effective ( 666.2 ±37.5 EUR vs. 718.0 ±69.2 EUR ; p < 0.01 ) . No major complications were observed in both groups . Conclusions In total thyroidectomy operations , the harmonic FOCUS is safe and facilitates dissection , allowing for a significant decrease in operative time . Other benefits include lower blood loss and a slightly decreased cost of the procedure Purpose The Harmonic Ace ultrasonic scalpel has been popular in abdominal surgery ; however , only a few clinical studies have evaluated the efficacy of this device in radical open gastrectomy for gastric cancer . Methods The present study was design ed as a multicenter , prospect i ve , r and omized , controlled trial . Patients with resectable gastric cancer were r and omly assigned to gastrectomy using the Harmonic scalpel or conventional monopolar electrosurgery . Results A total of 248 patients were enrolled , and 123 patients were included in the Harmonic group and 114 patients were included in the conventional group . The demographics of the patients were well balanced between the groups . There was no significant difference in the length of the operation from skin incision to resection of the gastric specimen ( 141 ± 36 min in the Harmonic group vs. 147 ± 13 min in the conventional group ; p = 0.276 ) nor in the amount of blood lost ( 365 ± 293 vs. 336 ± 272 mL ; p = 0.434 ) . There was also no significant difference in the incidence of surgical complications or the post-surgical hospital stay between the groups . Conclusion The Harmonic scalpel procedure was not superior to the conventional monopolar electrosurgery with regard to reducing the length of the operation , blood loss , postoperative complications , or postoperative hospital stay in radical open gastrectomy Objective : To assess the impact of postoperative complications on full in-hospital costs per case . Background : Rising expenses for complex medical procedures combined with constrained re sources represent a major challenge . The severity of postoperative complications reflects surgical outcomes . The magnitude of the cost created by negative outcomes is unclear . Patients and Methods Morbidity of 1200 consecutive patients undergoing major surgery from 2005 to 2008 in a tertiary , high-volume center was assessed by a vali date d , complication score system . Full in-hospital costs were collected for each patient . Statistical analysis was performed using a multivariate linear regression model adjusted for potential confounders . Results : This study population included 393 complex liver/bile duct surgeries , 110 major pancreas operations , 389 colon resections , and 308 Roux-en-Y gastric bypasses .  The overall 30-day mortality rate was 1.8 % , whereas morbidity was 53.8 % . Patients with an uneventful course had mean costs per case of US$ 27,946 ( SD US$ 15,106 ) . Costs increased dramatically with the severity of postoperative complications and reached the mean costs of US$ 159,345 ( SD US$ 151,191 ) for grade IV complications . This increase in costs , up to 5 times the cost of a similar operation without complications , was observed for all types of investigated procedures , although the magnitude of the increase varied , with the highest costs in patients undergoing pancreas surgery . Conclusion : This study demonstrates the dramatic impact of postoperative complications on full in-hospital costs per case and that complications are the strongest indicator of costs . Furthermore , the study highlights a relevant savings capacity for major surgical procedures , and supports all efforts to lower negative events in the postoperative course Background The aim of the study was to evaluate the potential advantages of the ultrasonic scalpel compared with the conventional technique in gastric cancer surgery . Methods Patients with resectable adenocarcinoma of the stomach were r and omly assigned to ultrasonic scalpel or conventional technique . We used the HARMONIC FOCUS ® ( Ethicon Endo-Surgery , Inc. ) as ultrasonic scalpel . Results Between February 2010 and December 2010 , 60 patients with resectable gastric cancer were enrolled into the study .  Operative time was significantly shorter with the ultrasonic arm than with the conventional arm ( median 238.5 vs. 300.5 min ; P = 0.0004 ) . Blood loss was also significantly lower in the ultrasonic arm than in the conventional arm ( median 351.0 vs. 569.5 ml ; P = 0.016 ) . Clavien – Dindo grade s of postoperative complications were similar in the two groups . From a question naire survey of operators , the ultrasonic scalpel significantly reduced the stress of lymph node dissection ( 3.67 vs. 2.87 ; P = 0.0006 ) . However , in assisting surgeons , the contributions to surgery , study , and technical improvement of the ultrasonic group were lower than in the conventional group . Conclusions This study shows that the ultrasonic scalpel is a reliable and safe tool for open gastric cancer surgery BACKGROUND The ultrasonic scalpel is a recently introduced device in head and neck surgery . Total thyroidectomy is the most common endocrine procedure performed by surgeons . METHODS This was an open , phase IV , multicenter , r and omized controlled trial ( RCT ) that compared the use of an ultrasonic scalpel with a conventional technique in patients who underwent total thyroidectomy . The outcomes were surgical complication rate , operative time , drainage volume , postoperative pain , and costs . RESULTS In all , 261 patients were included in 11 centers . There was a mean difference of 17 % of operative time in favor of the ultrasonic scalpel group . There were no differences in postoperative complications . There was a difference in costs of 14 % in favor of the ultrasonic scalpel group , but it was not statistically significant . CONCLUSIONS The use of an ultrasonic scalpel was as safe as that of the conventional technique and had the advantage of a shorter operative time and lower postoperative drainage . Costs were not different between groups BACKGROUND The Nissen fundoplication is currently the most commonly performed antireflux surgery whether performed as an open procedure or through the laparoscope . Extensive experience with open Nissen fundoplication has shown that dividing the short gastric vessels to mobilize the fundus ensures that the wrap will be loose and without tension . The st and ard laparoscopic technique for fundal mobilization is dissecting out the short gastric vessels , applying hemoclips , and then dividing them . For surgeons new to laparoscopic surgery , this can be an intimidating task . Introduction of the ultrasonic coagulating shears , a new energy source technology , offered the possibility of making this process quicker and easier . STUDY DESIGN We present a r and omized prospect i ve study comparing two methods of ligating the short gastric vessels during laparoscopic fundoplication .  Thirty-one patients were enrolled and r and omized into two groups : those who underwent short gastric ligation by dissection , clipping , and dividing , and those in whom the ultrasonic laparoscopic coagulating shears were used . The results were tabulated and subjected to statistical analysis . RESULTS Fifteen patients had laparoscopic fundoplication with ligation of the short gastric vessels by using clips 
    Output:
    
The results from all sensitivity analyses demonstrated cost reductions with Harmonic devices .
Conclusion This systematic review and meta- analysis showed that despite a higher device cost , Harmonic devices provide a statistically significant reduction in procedure costs , derived primarily from a reduction in operating time costs , across surgical procedures .
In addition to functionality benefits , Harmonic devices may represent a potentially cost saving method to reduce overall hospital re source use .