Abstract
A COMPARATIVE STUDY BETWEEN HARMONIC SCALPEL HEMOSTASIS AND CONVENTIONAL HEMOSTASIS IN TOTAL AND SUBTOTAL THYROIDECTOMY Mohammed Salim Mohammed*, Jasim D Saud#, Mansour Amin Mohammed$ & Mazin H Al-Hawaz@ *MB,ChB, Board Candidate. #MB,ChB, FICMS, CABS, Consultant Surgeon, Basrah General Hospital. $MB,ChB, DS, CABS, MRCS, Lecturer, Dept. of Surgery, College of Medicine. @ MB,ChB, CABS, DGS, FRCS, Prof. of General Surgery, Basrah Medical College., Basrah, IRAQ. Abstract Thyroid gland is highly vascularized organ, so good hemostasis during total or sub-total thyroidectomy is crucial to decrease the complications and to improve the outcome. This study aimed to evaluate the advantages and disadvantages of using harmonic scalpel device in comparison with conventional hemostasis for total and subtotal thyroidectomy in terms of operative time, nerves injury, post-operative blood loss, hematoma development, hypocalcemia and length of hospital stay. This study included 80 patients who underwent total or subtotal thyroidectomy. They were divided into two groups according to the type of hemostasis: conventional hemostasis group and harmonic hemostasis group. Different diseases were included (multinodular goiter, toxic goiter and malignant diseases). The results showed that time of operation was significantly shorter in the harmonic hemostasis group (79.52±14.98 min) than conventional hemostasis group (100.92 ±10.64 min) with p value 0.0001, also post-operative blood loss was lower in harmonic hemostasis group (52.5±26.23 ml) than conventional hemostasis group (75.13±17.8 ml) with p value 0.0001. Other outcome such as recurrent laryngeal nerve injury, post-operative hematoma, post-operative hypocalcemia and length of hospital stay did not show significant difference between the groups. In conclusion, using harmonic scalpel device in total or subtotal thyroidectomy reduced the operative time and post-operative blood loss, without any change in the incidence of nerve injury, hematoma, hypocalcemia and the length of hospital stay.
Highlights
IntroductionThe first mentioned goiter was in China as early as 2700 BC, and the first described thyroidectomy was done by Abulkasim Alzahrawi in 936 AD1
Goiter has been recognized since earliest recorded history
The aim of this study is to evaluate the harmonic scalpel advantages compared with conventional hemostasis in terms of operative time, nerves injury, postoperative blood loss, hematoma development, hypocalcemia and length of hospital stay
Summary
The first mentioned goiter was in China as early as 2700 BC, and the first described thyroidectomy was done by Abulkasim Alzahrawi in 936 AD1. Trials to treat thyroid enlargement and hyperactivity were associated with high mortality and morbidity due to asphyxia and hemorrhage. Thyroid surgery continued with high mortality rate (>40%); until the second half of the nineteenth century, as the first acceptable technique of standardized thyroid surgery which led to decrease mortality and morbidity was described by Theodor Kocher (1841-1917 AD) and Theodor Billroth (1829-1894 AD)[2]. Thyroid gland has rich blood supply, so proper hemostasis in thyroidectomy is crucial to avoid intraoperative bleeding, to obtain good surgical field, and to prevent injury to laryngeal nerves and parathyroid glands[3]. Since the development of Harmonic Scalpel (HS) by Ethicon in early 1990s (which was introduced for abdominal and laparoscopic procedures at the beginning), Bas J Surg, December, 23, 2017
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