Abstract
Haemostasis is crucial in thyroid surgery to avoid intraoperative and postoperative complications. In the present study, we evaluated the efficiency and the safety of Harmonic scalpel when compared to conventional suture ligation in open total thyroidectomy. We enrolled 265 patients who underwent total thyroidectomy for multinodular disease since October 2011 up to October 2013. They were randomized into two groups: 141 in group HS (Harmonic Scalpel), 124 in group CT (Conventional tecnique). We recorded the following data: operative time, post-operative blood loss, length of hospital stay and complications. The patients were monitored for 48 hours after surgery. Several differences were observed between the two groups (HS vs CT): the use of Harmonic scalpel was associated to a significant reduction of surgical operative time (110 min in CT vs 79.36 min in HS, p = 0.00001) and also associated to a lower blood loss (97.38 ml in CT vs 68.72 ml in HS, p = 0.00001). The length of stay was significantly shorter in the HS group (2.75 days in CT vs 1.93 days in HS) Complication rate was similar in the two groups. According to our experience, the Harmonic scalpel represents a safe alternative to conventional haemostasis in thyroid surgery, allowing for a significant reduction of operative time, blood loss and hospitalization. The rate of complication demonstrated no significant difference among the two groups.
Highlights
The technique of thyroidectomy was born in 19Th century (Hannan 2006), but during the last year various technique of hemostasis, neuromonitoring and surgical excision (MiVATT, loupes assisted, endoscopic, robotic, ToVAT) are invented
Endocrine surgery Unit, “Policlinico-Vittorio Emanuele” Hospital, Catania, Italy using mechanical vibration at a frequency of 55.5 KHz. It was introduced for abdominal and laparoscopic surgery (Laycock et al 1996; Amaral 1994), the Harmonic scalpel device demonstrated some advantages in thyroidectomy in several published studies (Bandi et al 2008; Ferri et al 2011; Ecker et al 2010). The aim of this prospective randomized study is to evaluate the real benefits of the Harmonic when compared with conventional ligation, in terms of operative time, postoperative blood loss, length of stay and complications
With the method of sealed envelope, into two groups according to the haemostatic technique: 124 patients were included in Conventional group (CT), in whom dissection and hemostasis were performed using conventional materials (Vicryl 3-0/4-0, stitches, V titanium hemostatic clips and monopolar or bipolar electrocautery); 141 were included in Harmonic scalpel group (HS), in which the Harmonic Focus was used: the application of ultrasound to tissues was performed during the enterely procedure, to obtain three purposes synergistically: coagulation, cutting, and cavitation (Figure 1)
Summary
The technique of thyroidectomy was born in 19Th century (Hannan 2006), but during the last year various technique of hemostasis, neuromonitoring and surgical excision (MiVATT, loupes assisted, endoscopic, robotic, ToVAT) are invented. Total thyroidectomy is performed in several thyroid diseases and a meticulous hemostasis is important to preserve the parathyroid glands and recurrent nerves. In the 1990, the Harmonic scalpel was developed by Ethicon as an alternative to conventional hemostatic tecniques: the device allows simultaneous cutting and coagulation of vessels by. The aim of this prospective randomized study is to evaluate the real benefits of the Harmonic when compared with conventional ligation, in terms of operative time, postoperative blood loss, length of stay and complications
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