Background: Hemorrhoidal disease is one of the most frequently encountered anorectal conditions in the clinical practice. A variety of instruments including circular staplers, harmonic scalpel, laser, and bipolar electrothermal devices are currently used when performing hemorrhoidectomy grades III and IV. Objective: This study compares outcomes between hemorrhoidectomy performed with harmonic scalpel and conventional methods. Materials and methods: A prospective randomized study of consecutive 50 patients who underwent hemorrhoidectomy between January 2017 and October 2017. Patients were randomly enrolled in two different groups. Group I consisted of 25 patients who underwent hemorrhoidectomy using an ultrasonic scalpel device (harmonic) and group II with 25 patients who had conventional hemorrhoidectomy. Results: The patients’ demographics data and clinical characteristics were similar in both groups. The harmonic group had a shorter operation time, less postoperative pain, less postoperative bleeding, and shorter hospital stay. Conclusion: Harmonic scalpel hemorrhoidectomy appears to be a better procedure for symptomatic grades III and IV hemorrhoids with ease of operating due to less bleeding, less postoperative pain, and patient acceptance. Long-term follow-up with larger scale studies is required.