Evaluation of harmonic scalpel [SH] in thyroid surgery: a prospective randomized study

ABSTRACT

The harmonic scalpel [HS] using mechanical vibration rather than high temperature has been widely used in laparoscopic surgery and is documented to be safe and fast for cutting and coagulating tissues. We studied whether the use of [HS] could have advantages in thyroid surgery compared to conventional thyroidectomy. Our study was a prospective randomized trial of thyroidectomies performed for benign thyroid diseases between March 2004 and August 2005 in Cairo University Hospital. Patients were randomized into 2 groups group A [n=50] underwent thyroidectomy using HS and group B [n=50] with the conventional technique, clamp and tie and electrocautery. The outcome measures in this study included operative time; postoperative drainage; hospital stay; and procedure complications including recurrent laryngeal nerve injury RLN as well as hypoparathyroidism. The two groups were similar in age and sex. Mean -+SD operative time was shorter in the SH group compared with the conventional group for both hemithyroidectomy [61- +6vs 78- + /10 minutes] and subtotal thyroidectomy [86- +2Ovs 101-+ / 6minutes]. The difference was statistically significant. There were no statistically differences between the two groups regarding transient postoperative complications. There was no mortality in both groups and no intraoperative complications or postoperative definitive sequelae. We concluded that the use of HS is safe in thyroidectomy it does not reduce or increase operative morbidity but has a clear advantage of reducing operative time by almost 30 minutes. These results my have implications for significant hospital cost saving. By shortening operative anesthesia time the use of HS might accelerate postoperative recovery. Further studies are needed to show the cost-effectiveness of both techniques