To present our technique using the harmonic scalpel for scrotal, extensive hydrocelectomy in adolescents and its advantages, compared with the historical techniques.

Scrotal hydrocelectomy is an old-timer procedure in-which the Lord plication, the Jaboulay and the bottleneck techniques are the standard of care, up to date. A cumbersome, unpleasant scrotal dressing is commonly used to try to mitigate postoperative edema and hematoma.<sup>1Complications of Surgery of the Testicle, Vas Deferens, Epididymis, and Scrotum. James Wren and Robert Brannigan Campbell-Walsh-Wein Urology, Twelfth Edition. Elsevier; 2021:53, 567-579.e4.

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The harmonic scalpel denaturates proteins by ultrasonic vibrations, and provides advantages over conventional electrocautery with respect to bleeding, drain volume, postoperative pain, and the return to normal activity.<sup>2Foschi D., Cellerino P., Corsi F., e al. The mechanisms of blood vessel closure in humans by the application of ultrasonic energy Surg Endosc 2002 ;  16 : 814-819 [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 3Potts Kevin L., Augenstein Adam B.S., Goldman Julie L. A parallel group analysis of tonsillectomy using the harmonic scalpel vs electrocautery Arch Otolaryngol Head Neck Surg 2023 ;  131 : 49-51

Cliccare qui per andare alla sezione Riferimenti, 4Kim J., Shin Y., Jeong W. Harmonic scalpels compared with electrocautery in reconstructive flap harvesting: a meta-analysis Microsurgery 2022 ;  42 : 89-96 [inter-ref]

Cliccare qui per andare alla sezione Riferimenti, 5Takebayashi K., Shiomi H., Naka S., e al. Utility of a microwave surgical instrument in sealing lymphatic vessels Am J Surg 2013 ;  206 : 229-233 [inter-ref]

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Adolescents with a large hydrocele, and no inguinal hernia were selected for this operation. All tissue layers except the skin were divided by harmonic scalpel Focus (Eticon).

Between 2017 and 2023, 43 adolescents at a median age of 14.3years (range 12-18years), were operated with this technique, using the harmonic scalpel, by a single surgeon. Median operative time was 23 minutes (range 18-35 minutes). No scrotal dressing was used. One patient had a postoperative seroma that was drained spontaneously.

The described technique is simple and time-saving, with no postoperative major edema nor hematoma in this series. The only disadvantage is the higher cost of the harmonic scalpel, that may be offset by a short time of recovery. Following our experience, we no longer use other techniques for this surgery.