A Study to Compare the Safety and Efficacy of Cutting Electrocautery Versus Scalpel Skin Incisions in Elective Abdominal Surgeries

Background: Skin incision is an important initial step in elective abdominal surgery and may influence operative blood loss, incision time, postoperative pain, and wound outcomes. Although the scalpel remains the conventional method, cutting electrocautery offers simultaneous tissue division and haemostasis. Concerns regarding thermal tissue injury and impaired wound healing have limited its widespread acceptance. This study was undertaken to compare the safety and efficacy of cutting electrocautery with conventional scalpel skin incision in elective abdominal surgery. Aim: To compare the efficacy and safety of cutting electrocautery versus traditional scalpel for skin incisions in elective abdominal surgical procedures, with particular emphasis on incision time, intraoperative blood loss, postoperative pain, surgical site infection, hospital stay, and cost-effectiveness. Materials and Methods: A prospective comparative study was conducted over 18 months from May 2024 to October 2025 in the Department of General Surgery, Narayana Medical College, Nellore. Sixty patients undergoing elective abdominal surgery were included and assigned alternately into two groups of 30 each. Skin incision was made using a scalpel in one group and cutting electrocautery in the other. Incision time and intraoperative blood loss were recorded, while postoperative pain and wound infection were assessed during the first postoperative week. Continuous and categorical variables were analysed using Student’s t-test, Chi-square test, or Fisher’s exact test, with p<0.05 considered statistically significant. Results: The two groups were comparable with respect to age and sex. Mean incision time was slightly lower with electrocautery than scalpel (82.83 vs. 87.77 seconds), but the difference was not statistically significant (p=0.22). Intraoperative blood loss was significantly lower in the electrocautery group (11.42 ml vs. 17.88 ml; p<0.001). Postoperative pain was significantly lower with electrocautery on postoperative days 1 (5.16 vs. 6.09; p=0.007), 3 (3.63 vs. 4.18; p=0.02), and 7 (1.45 vs. 2.16; p=0.003). Surgical site infection occurred in two patients in each group (p=1.00). Mean hospital stay was slightly shorter in the electrocautery group (4.40 vs. 4.83 days), although the difference was not statistically significant (p=0.20). The cost-effectiveness score was significantly higher with electrocautery (68.05 vs. 37.71; p<0.001). Conclusion: Cutting electrocautery is a safe and effective alternative to conventional scalpel for skin incisions in elective abdominal surgery. It significantly reduces intraoperative blood loss and postoperative pain while maintaining comparable incision time, surgical site infection rates, and duration of hospital stay. Its superior cost-effectiveness further supports its use in elective abdominal procedures. Keywords: Cutting electrocautery; Scalpel; Skin incision; Intraoperative blood loss; Postoperative pain