Abstract
Background: Maintaining hemostasis is considered a remarkable challenge during total thyroidectomy. The use of thermal ultrasonic electrocoagulation (harmonic scalpel) for total thyroidectomy was recently introduced to substitute the conventional ligation methods. However, controversies exist on the efficacy of this technique compared to the classic method.
 Methods: The data regarding this prospective cohort study was gathered between March 2019 to March 2020. Ninety participants were enrolled in the study. Forty-five subjects received harmonic scalpel ligation and the other forty-five participants underwent conventional total thyroidectomy. Afterward, these two groups were statistically compared regarding surgical time, postoperative hypocalcemia, drainage volume, postoperative pain, hospital stay, and recurrent nerve damage.
 Results: No significant difference was detected in the group undergoing harmonic ligation concerning postoperative pain, postoperative hospital stay, drainage volume, and postoperative hypocalcemia in the first 48 hours post-operation. However, using a harmonic scalpel significantly reduced the surgical time (56 ± 2 minutes in the harmonic scalpel group versus 67 ± 9 in the conventional technique group, p < 0.001). Also, no recurrent nerve damage was detected in the study.
 Conclusions: Utilizing a harmonic scalpel has a remarkably higher time efficacy in total thyroidectomy. However, the study suggests no further advantage for this method compared to the conventional techniques in total thyroidectomy.
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