A Comparison of the Usefulness and Safety of the Harmonic™ Scalpel, Ligasure™ System, and Classic Clamp-and-Tie Technique for Hemostasis during Thyroid Surgery / 대한내분비외과학회지

PURPOSE: The aim of this study was to compare the outcome of total thyroidectomy performed with the Ligasure™ system, Harmonic™ scalpel, and the conventional clampand-tie technique. METHODS: Between November 2006 and July 2009, the data were retrospectively collected from 600 consecutive total thyroidectomies by one surgeon. All cases were divided into 3 groups based on the method of hemostasis: classic group patients (n=200) underwent total thyroidectomy with the conventional clamp-and-tie technique Ligasure group patients (n=200) underwent total thyroidectomy with the Ligasure™ system (electrothermal bipolar vessel sealing system) and the Harmonic group patients (n=200) underwent total thyroidectomy with a Harmonic™ scalpel (ultrasonic cutting and coagulating surgical device). We compared the clinical outcomes with respect to the operative time, amount and duration of drainage, hospital stay, and post-operative complications. RESULTS: The three groups were similar with respect to clinical and demographic characteristics, with the exception of invasiveness. The mean operative time of the Harmonic group was significantly shorter than the other 2 groups (P<0.001) specifically, 75 min in the Harmonic group, 87 min in the Ligasure group, and 120 min in the classic group. The amount of drainage in the Harmonic group was greater than the other groups (P<0.001). Similarly, the duration of drainage and hospital stay of the Harmonic group were longer than the other groups. There was no significant difference in the incidence of complications between the three groups. CONCLUSION: Hemostasis during thyroidectomy by the Harmonic™ scalpel or Ligasure™ system was safe and timesaving. Therefore, the Harmonic™ scalpel and Ligasure™ system will be available for thyroid surgery as alternative techniques for the clamp-and-tie technique.

Endoscopic Thyroidectomy via an Axillo-bilateral Breast Approach: 5 Years of Experience / 대한내분비외과학회지

PURPOSE: Conventional surgery for thyroid disease requires long skin incisions and can lead to prominent scars of the neck, adhesions, hypoesthesia, and paresthesia. To overcome these problems we performed an endoscopic thyroidectomy via an axillo-bilateral breast approach. METHODS: Seventy patients with benign thyroid nodules by fine needle aspiration were selected. Patients underwent endoscopic thyroidectomy via axillo-bilateral breast approach from May, 2003, through November, 2007. RESULTS: Operations included 67 lobectomies, 1 isthmectomy, and 2 total thyroidectomies. Two cases were converted to an open thyroidectomy because of bleeding. The mean operating time was 90.6 min (range, 60~170). The mean length of hospital stay was 6.39 days (range, 4~12), and the mean duration of drainage was 3.87 days (range, 2~9). Postoperative hematoma for 3 patients was observed, but absorbed spontaneously. Two patients complained of hoarseness and 1 patient had vocal cord palsy, but these disappeared during follow-up. CONCLUSION: This approach resulted in satisfactory cosmetic results and no significant complications. We believe that endoscopic thyroidectomy via an axillo-bilateral breast approach is feasible and safe.