DOI: http://dx.doi.org/10.18203/2349-2902.isj20201372

A comparative study between harmonic scalpel hemostasis and conventional hemostasis in total thyroidectomy

Waleed Yusif El Sherpiny

Abstract


Background: Thyroidectomy is the most commonly performed procedure in endocrine surgery. Since the thyroid gland is highly vascular, therefore, rapid and absolute hemostasis is extremely required. Conventional thyroidectomy is commonly used with acceptable outcomes, however, it is time‑consuming and resulted in significant intraoperative blood loss with the possible risk of postoperative hemorrhage, injury to parathyroid glands and laryngeal nerves. The advent of focus harmonic devices was encouraging for improving safety, effectiveness, and reduction of operative time, especially in thyroid surgery. Aim of this study: The purpose of this study was to analyze the effectiveness and surgical outcomes of using ultrasonic harmonic scalpel for thyroid surgery compared to conventional techniques.

Methods: This was a prospective, randomized study in which 60 patients with various types of goiters presented for thyroidectomy. The patients were divided into two comparable groups. Group A (30 patients) included patients who had focus harmonic thyroidectomy and Group B (30 patients) included patients who underwent conventional thyroidectomy.

Results: Focus harmonic thyroidectomy showed a significant reduction in operative time, intraoperative blood loss, volume of postoperative fluid drainage and meantime for hospital stay compared with conventional thyroidectomy. There were no significant differences in the incidence of postoperative hypocalcemia, seroma, hematoma, wound infection and laryngeal nerve injury between both groups.

Conclusions: Focus harmonic thyroidectomy was a safe, effective, faster, and appealing alternative to conventional technique since it reduced the operative time, intraoperative blood loss, postoperative drainage and hospital stay with comparable postoperative complications. 


Keywords


Conventional thyroidectomy, Focus harmonic scalpel, Sutureless thyroidectomy

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References


Mercic MA, Kaplan EL, Gaz RD, Slough CM. History of thyroid and parathyroid surgery. In: Radolph GW (ed). Surgery of Thyroid and Parathyroid Gland. Philadelphia: Elsevier; 2013: 1-3.

Cannizzaro MA, Bianco SL, Borzi L, Cavallaro A. The use of FOCUS harmonic scalpel compared to conventional hemostasis (knot and tie ligation) for thyroid surgery: a prospective randomized study. Springer Plus. 2014;3:639-43.

Duan YF, Xue W, Zhu F, Sun D. Focus harmonic scalpel compared conventional hemostasis in open total thyroidectomy a prospective randomized study. J Otolaryng Head Neck Surg. 2016;42:62.

Siperstein AE, Berber E, Morhoym E. The use of the harmonic scalpel vs conventional knot tying for vessel ligation in thyroid surgery. Arch Surg. 2002;137(2):137-42.

Nenkov R, Radev K, Marinova E, Cvetkov N. The harmonic scalpel application in thyroid surgery. JIMAB. 2013;19:408-11.

Sista F, Schietoroma M, Ruscitti C, Santis GD. New ultrasonic dissector versus conventional hemostasis in thyroid surgery: a randomized prospective study. Journal Laparoend-Oscopic Advan Surg Tech. 2012;22(3):220-4.

Ecker T, Cavalho AL, Choe JH, Walosek G, Preuss KJ. Hemostasis in thyroid surgery: harmonic scalpel versus other techniques a meta-analysis. Otolaryngol Head Neck Surg. 2010;143:17-25.

Ruggiero R, Docimo L, Tolone S, Palma M, Musella M, Pezzolla A, et al. Effectiveness of an advanced hemostatic pad combined with harmonic scalpel in thyroid surgery: a prospective study. Int J Surg. 2015;17:174-6.

Miccoli P, Materazzi G, Miccoli M, Frustaci G, Fosso A, Berti P. Evaluation of a new ultrasonic device in thyroid surgery: comparative randomized study. Am J Surg. 2010;199:736-40.

Miccoli P, Berti P, Dionigi G, D’Agostino J, Orlandini C, Donatini G. Randomized controlled trial of harmonic scalpel use during thyroidectomy. Arch Otolaryngol Head Neck Surg. 2006;132:1069-73.

Mohamed WBA, Ahmed AE. Sutureless versus conventional thyroidectomy. Int Surg J. 2017;4:1385-8.

Ali MNM, Aldardeer AA, Ali AMA, Radwan AA. Total thyroidectomy: conventional suture ligation technique versus sutureless techniques. Int Surg J. 2019;6:1862-9.

Contin P, Goossen K, Grummich K, Jensen K, Schmitz WH, Buchler MW, et al. Energized vessel sealing systems versus conventional hemostasis techniques in thyroid surgery the enercon systematic review and network meta-analysis. Langenbecks Arch Surg. 2013;398:1039-56.

Singhal A, Baskota DK, Acharya K. Ultrasonic cutting and coagulation device versus conventional diathermy dissection in thyroid surgery: prospective randomized trial. Int J Otorhinolaryngol Head Neck Surg. 2018;4:335-8.

Yener O, Demir M, Yılmaz A, Yıgıtbaşı R, Atak T. Harmonic scalpel compared to conventional hemostasis in thyroid surgery. Indian J Surg. 2014;76(1):66-9.

Ab N, Aslam MA, Nair PP. Prospective randomized study using focus harmonic scalpel versus conventional hemostasis for vessel ligation in open thyroid surgery. Int Surg J. 2017;4(4):1431.

Cirocchi R, Ajello F, Trastulli S, Santoro A, Di Rocco, Vendettuoli D, et al. Meta-analysis of thyroidectomy with ultrasonic dissector versus conventional clamp and tie. World J Surg Oncol. 2010;8:112.

Sukprasert M, Choktanasiri W, Ayudhya NI, Promsonthi P, Prasertsawat P. Increase accuracy of visual estimation of blood loss from education program. J Med Assoc Thai. 2006;89(4):54-9.

Pacagnella RC, Souza JP, Durocher J. A systematic review of the relationship between blood loss and clinical signs. Plos One. 2013;8(3):57594.

Saber A, Elela ST, Shaalan KM, Masry AR. Preoperative prediction of the difficulty of laparoscopic cholecystectomy. J Surg Surgical Res. 2015;1(1):15-8.

Kpolugbo J, Uhumwangho O, Obasikene G, Alili U. Blood transfusion, antibiotics use, and surgical outcome in thyroid surgery: experience from a suburban center in Nigeria. Niger J Clin Pract. 2012;15(4):458-61.

Coiro S, Frattaroli FM, De Lucia F, Manna E, Fabi F, Frattaroli JM, Pappalardo G. A comparison of the outcome using Ligasure™ small jaw and clamp-and-tie technique in thyroidectomy: a randomized single-center study. Langenbecks Arch Surg. 2015;400(2):247-52.

Hirunwiwatku P, Tungkavivachagul S. A multicenter, randomized, controlled clinical trial of ligasure small jaw vessel sealing system versus conventional technique in thyroidectomy. Eur Arch Otorhinolaryngol. 2013;270(7):2109-14.

Wael AJ, Mohamed RA, Aly S. Use of ligasure sealing versus conventional suture - ligation in total thyroidectomy. J Surg. 2016;4:34-8.

Noori IF, Mohammad MA. Sutureless focus harmonic thyroidectomy versus conventional clamping and knot tying technique. Med J Babylon 2018;15:300-5.

Regmi D, Toran KC, Bista M, Shrestha S. Comparison of surgical outcomes of ultrasonic technique (harmonic focus™) with conventional technique in open hemithyroidectomy. J Kathamandu Med Coll. 2013;2:175-80.

Rienzo RM, Bove A, Bongarzoni G, Palone G, Corradetti L, Corbellini L, et al. Comparison of conventional technique, ligasure precise and harmonic focus in total thyroidectomy. G Chir. 2010;31:296‑8.

Dhahiry JK, Hameed HM. Total thyroidectomy: conventional suture ligation technique versus sutureless techniques using harmonic scalpel or maxium. Ann Med Surg. 2016;5:29‑34.

Cheng H, Soleas I, Ferko NC, Clymer JW, Amaral JF. A systematic review and meta-analysis of harmonic focus in thyroidectomy compared to conventional techniques. Thyroid Res. 2015;8:15.

Ortega J, Sala C, Flor B, Lledo S. Efficacy and cost‑effectiveness of the ultracision harmonic scalpel in thyroid surgery: an analysis of 200 cases in a randomized trial. J Laparoendosc Adv Surg Tech. 2004;14:9-12.

Defechereux T, Rinken F, Maweja S, Hamoir E, Meurisse M. Evaluation of the ultrasonic dissector in thyroid surgery: a prospective randomized study. Acta Chir Belg. 2003;103:274-7.

Cordón C, Fajardo R, Ramírez J, Herrera MF. A randomized, prospective, parallel-group study comparing the harmonic scalpel to electrocautery in thyroidectomy. Surg. 2005;137:337-41.

Shemen L. Thyroidectomy using the harmonic scalpel: analysis of 105 consecutive cases. Otolaryngol Head Neck Surg. 2002;127:284-8.

Voutilainen PE, Haglund CH. ultrasonically activated shears in thyroidectomies: A randomized trial. Ann Surg. 2000;231:322-8.

Manouras A, Lagoudianakis EE, Antonakis PT, Filippakis GM, Markogiannakis H, Kekis PB. Electrothermal bipolar vessel sealing system is a safe and time-saving alternative to classic suture ligation in total thyroidectomy. Head Neck. 2005;27:959-62.

Lachanas VA, Prokopakis EP, Mpenakis AA, Karatzanis AD, Velegrakis GA. The use of ligasure vessel sealing system in thyroid surgery. Otolaryngol Head Neck Surg. 2005;132:487-9.

Anandaravi BN, Aslam MA, Nair PP. Prospective randomized study using Focus Harmonic Scalpel versus conventional hemostasis for vessel ligation in open thyroid surgery. Int Surg J. 2017;4:1431-7.

Ferri E, Armato E, Spinato G, Spinato R. Focus harmonic scalpel compared to conventional hemostasis in open total thyroidectomy: A prospective randomized trial. Int J Otolaryngol. 2011;2011:357195.

Ciftici F. Differences in thyroidectomy outcomes based on surgical method: a comparison of ligasure precise, harmonic focus and traditional methods. Int Surg. 2016;101:121-6.