COMPARISON BETWEEN POSTOPERATIVE DRAIN OUTPUT AFTER THYROIDECTOMY WITH AND WITHOUT USE OF HARMONIC SCALPEL DEVICE

Abstract

Abstract:
 Introduction: Thyroid gland is one of the most important endocrine organs in human body performing multiple functions to maintain homeostasis. Thyroid nodular disease is a frequently encountering problem in surgical OPD that could be malignant or benign. It is more common in females than in males and is expecting that after a decade or so, it will be the 2nd most common malignancy in women. Ultrasound guided fine-needle aspiration (FNA) and core needle biopsy (CNB) are two modalities use to diagnose thyroid swelling preoperatively. Multiple techniques are used to manage thyroid swellings, depending on type and size of thyroid enlargement. Total thyroidectomy, radical and subtotal thyroidectomies are few examples. As thyroid has rich blood supply, ensuring early hemostasis is of vital importance as it directly affects duration of operation as well as visibility of surgical site and intra operative bleeding. Newer techniques include use of harmonic scalpel device that can seal and dissect blood vessels simultaneously by coagulating proteins present in blood vessels, decreasing duration of operation and better hemostasis.
 Objective: This study was done to evaluate the operative duration, post-operative complications and drain output after thyroidectomy with and without use of harmonic scalpel device. 
 Material and Methods: Randomized controlled trial was conducted at Surgical Unit 3 of Lahore General Hospital between July 2018 and June 2019. Written informed consent was acquired from all of the patients. All participants underwent near total or total thyroidectomy and were euthyroid at the time of surgery. All participants were randomly allocated to one of the two study groups using lottery method. All the data was collected using preformed questionnaire and was evaluated through SPSS v 25.
 Inclusion criteria: Age group of 20–70 years and American Society of Anesthesiologists (ASA) physical status I–II.
 Exclusion criteria: Morbidities (e.g., coagulopathy, diabetes, hypertension, ischemic heart disease).
 Results: Out of 50 patients 35 patients were female with mean age group of 47±4.8 years. 25 participants were enrolled in group in which Harmonic Scalpel device was used while 25 patients underwent conventional method. Mean duration of thyroidectomy from skin incision to skin closure in group with use of harmonic scalpel was 104.19±13.67 minutes while in conventional group it was 128.62 ± 11.76 minutes. Mean output of fluid/blood in drain post operatively in group treated with harmonic scalpel was 48.82±16.56 while in conventional group, post-operative drain output was 89.45±23.21ml.
 Conclusion: Harmonic device is both useful and widely used hemostatic tool in thyroid gland surgery. This device is safe and more compelling than the conventional monopolar diathermy.