Harmonic Scalpel Versus Conventional Technique in Total Thyroidectomy (Comparative Study) (original) (raw)
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Traditional haemostatic technique in thyroidectomy may cause some damages to surrounding tissues and it is time consuming. It is believed that these damages and the time can be reduced using ultrasonic dissector devices like Harmonic Scalpel. In this study, we investigate the benefits of harmonic Scalpel haemostasis (HS) versus conventional haemostatic techniques (CT) in total thyroidectomy. Analysis of patient's data was done for cases with total thyroidectomies performed between 2011and 2015 by the same surgeons using either the conventional technique (Clamp and Tie technique) or the harmonic scalpel for haemostasis. Gender, age, preoperative clinical information, histopathology results,and procedure type were analyzed. and according to the type of haemostatic techniques the collected patient's data was divided in to two groups; conventional group (CT group) in which the haemostasis was done with Clamp and Tie technique and harmonic scalpel group (HS group) in which the haemostasis was done with Harmonic Scalpel (Sonicbeat Olympus). The outcome and the complications of the both procedures were analyzed statistically and compared. The use of harmonic scalpel in total thyroidectomy significantly decreases mean operative time by (-37.635 min) 60.49±7.78 SD for HS group vs 98.13±14.165 SD for CT group with very significant P-value (0.0000). Statistical significant difference in the mean volume of postoperative drainage in (ml) through redivac drain observed between the two groups; 63.02±19.91SD for HS group and 72.50±22.79 SD for CT group with significant P-value (0.0000). There were no significant difference in the other parameters of the outcome and complications after total thyroidectomy in both groups. It is concluded from this study that main impact of harmonic scalpel in total thyroidectomy is the significant reduction in operative time and its use is safe and not associated with increase in the rate of the complications.
Thyroidectomy using the harmonic scalpel: A pilot study
Operative Techniques in Otolaryngology-Head and Neck Surgery, 2001
The harmonic scalpel has been successfully used in other surgical disciplines and general otolaryngology. We present a pilot study with the harmonic scalpel for 20 successive thyroidectomies. The advantages conferred by this instrument are superior hemostasis allowing for shortened operating time and smaller incisions.
Basrah Journal of Surgery, 2017
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.
BACKGROUND: The conventional thyroidectomy using knot and tie leads to increased operative time and bleeding but with the advent of harmonic scalpel (HS), which cuts and coagulates the tissues at the same time using a mechanical energy, has significantly decreased the operative time and bleeding. This study assessed to compare the mean operative time and mean post-operative bleeding time in sutureless thyroidectomy using harmonic scalpel with conventional thyroidectomy.
International Journal of Otorhinolaryngology and Head and Neck Surgery, 2019
Background: The pioneers of thyroid surgery, Theodor Kocher and Theodor Billroth, developed an acceptable technique of standardized thyroid surgery between 1873 and 1883. The aim of this prospective randomized trial was to evaluate the efficacy and safety of harmonic scalpel use compared with conventional haemostasis in open thyroid surgery.Methods: A total of 60 consecutive patients underwent open total thyroidectomy were randomized into two groups. Group A with harmonic scalpel and Group B with electrocautery with 30 patients each. Factors including age, sex, pathology, thyroid volume, haemostatic technique, operative time, drainage volume, thyroid weight, postoperative pain, postoperative complications and hospital stay. The results were analysed using the students t-test and x2.Results: No significant difference was found between the two groups concerning mean thyroid weight and mean hospital stay. The mean operative time was shorter in the harmonic scalpel group. The total flui...
TURKISH JOURNAL OF MEDICAL SCIENCES, 2014
This study was approved by the Ethics Committee of Kafkas University in Kars and performed according to the Declaration of Helsinki, between December 2006 and February 2011. Informed consent was obtained from each patient selected for the study. Indications for operation were determined by "Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer", which were developed by the American Thyroid Association Guidelines Taskforce in 2009. A total of 326 Aim: Both LigaSure (LS) and Harmonic Scalpel (HS) are new surgical technologies that have been used to secure hemostasis in various fields of surgery. There is little information in the literature about the use of LS and HS in thyroid surgery. The aim of this study was to report our experience with LS and HS in thyroid surgery. Materials and methods: In this nonrandomized retrospective study 326 consecutive patients who underwent primary thyroid surgery were reviewed. HS was used in 136 patients and LS was used in 126 patients. A conventional technique was used in 64 patients. The were 42 male patients (12.9%) and 284 female patients (87.1%); their ages varied between 19 and 72 years (mean 42.8 ± 12.4). Data regarding each patient's demographics, thyroid pathology, operation time, and complications were collected throughout the study. Results: The 3 study groups had similar demographics (age, female/male ratio) and thyroid pathology. Permanent hypocalcemia developed in 2 (1.6%) patients in the patient group operated on through LS, of which 1 was male and the other was female. In the HS group, postoperative hematoma developed in 2 (1.5%) patients. Conclusion: The results of this retrospective clinical study showed that LS and HS thyroidectomy can be a useful and fast alternative for conventional thyroidectomy. The main advantage of these devices is that they simplify the procedure and eliminate the need for clips and suture ligations while achieving efficient hemostasis.
The use of the harmonic scalpel in thyroidectomy: 'beyond the learning curve
Annals of The Royal College of Surgeons of England, 2009
INTRODUCTION Safe and effective haemostasis in surgery is clearly essential, and in the neck where risks of airway compromise are also present any new technology that purports to offer advantages must be rigorously evaluated. We describe our experience with the use of the Harmonic Scalpel [Ethicon UK] in thyroidectomy. PATIENTS AND METHODS A retrospective clinical review of 183 patients undergoing hemi or total thyroidectomies from 12 months prior to using the harmonic scalpel (2003; n = 77) and 12 months 'beyond the learning curve' (2006; n = 106). RESULTS The results demonstrate that, once past the learning curve, the use of the harmonic scalpel during thyroidectomy significantly reduces operative time and postoperative hypocalcaemia, and is as safe as conventional surgery with regard to voice change and bleeding. CONCLUSIONS The harmonic scalpel is as safe as conventional methods of haemostasis and operations using this technique are quicker once the need to have repetitive 'clip, cut and tie' routines is avoided.
The Professional Medical Journal
ORIGINAL PROF-4030 ABSTRACT… Objectives: To compare the mean operative time in subtotal thyroidectomy with harmonic scalpel and conventional vessel ligation method. Study Design: Randomized control trial. Setting: Surgical unit of Bakhtawar Amin Medical and Dental College Multan. Period: April 2015 to April 2016 for one year. Methodology: A total number of 92 cases were selected for this study and these were randomly divided into two equal groups by lottery method (Group A= operated with harmonic scalpel, Group B= operated with conventional vessel ligation method) each containing 46 patients. The sample size was calculated with the help of the WHO Sample Size Calculator. (WHO sample size determination software version of KC Lun and Peter Chiam). Sample Size, n= 92 (46 in each group). Expected mean operative time with harmonic scalpel method (44.9 ± 8.3 minutes) compared with the Conventional ligation method (69.5 ± 10.7 minutes; P < .001). Data was analyzed with the use of SPSS version 23. The frequency and percentage were calculated for qualitative variables like gender. Quantitative variables like age and operative time were presented as mean and standard deviation. T test was applied to compare the mean operative time between two groups. Results: A total number of 100% (n=92) patients were included in this study. Gender distribution showed that there were more males i.e 52.2% (n=48) and 47.8% (n=44) were females. The mean age of patients was 42.75 + 14.33 years. Recorded mean duration of operation time was 47.69 + 6.51 minutes for group A compared to the mean duration of operation of 71.61 + 7.32 minutes. This time difference was statistically significant with a p-value of < 0.001. Conclusion: Subtotal thyroidectomy with harmonic scalpel leads to a significantly reduced mean operative time compared to conventional vessel ligation technique and should be opted routinely for this surgical procedure.