To the Editor.—I read the article by Pearlman et al,1 published in the August 1991 issue of the Archives, with interest. The authors compare incisional time, blood loss, pain, and healing prospectively following incision with a carbon dioxide laser, scalpel, or electrocautery. Several observations and clarifications are in order.
While the authors purport to compare these surgical modalities in an unbiased fashion, it is clear that the study design is biased against scalpel and laser incisions. In both cases, bleeding is controlled with clamping and ligature, which, while an accepted method of management, will inevitably require more time and may well result in greater blood loss before the vessels are controlled with clamping. Wounds created by laser were begun with scalpel (probably producing additional blood loss) and then completed by laser.
Other, more subtle, design flaws exist in regard to the laser parameters used. The authors report using
Lanzafame RJ. Laser Use During Open Cholecystectomy. Arch Surg. 1992;127(3):360. doi:10.1001/archsurg.1992.01420030138027