Comparative study of sutureless thyroidectomy using harmonic scalpel versus vessel ligation thyroidectomy
DOI:
https://doi.org/10.18203/issn.2454-5929.ijohns20242040Keywords:
Hemostasis, Recurrent laryngeal nerve, Thyroidectomy, Sutureless thyroidectomy, Ultrasonic deviceAbstract
Background: Hemostasis is crucial for thyroidectomy surgery. Traditional methods used for hemostasis like suture ligation has a risk of knot slipping hence new methods of ligation became need of the hour. Harmonic scalpel is one such newer method of vessel ligation providing faster and precise ligation of vessels. The objective was to compare effectiveness of sutureless technique using harmonic scalpel in thyroid surgery with conventional suture ligation technique.
Methods: The 50 patients undergoing thyroid surgery were divided into two groups of 25 each. Group A underwent thyroid surgery using conventional suture ligation and group B underwent thyroid surgery using harmonic scalpel.
Results: Our results showed that in group B, none of the patients had change of voice and only 1 had transient hypocalcemia while 2 in group A had recurrent laryngeal paresis and 4 had transient hypocalcemia (not statistically significant). The average blood loss was less in group B as compared to group A (p=0.014), as was the post op drain collection 12.60 ml (p=0.034) as compared to 17.80 ml in group A, and the operative time 34.60 minutes (p=0.00) as compared to 45.44 minutes in group A. The overall cost was thus conspicuously reduced as compared to group A.
Conclusion: Sutureless thyroidectomy using harmonic scalpel is safe, fast and cost-effective technique to perform thyroidectomies.
Metrics
References
Kalra S, Unnikrishnan AG, Sahay R. The global burden of thyroid disease. Thyroid Res Pract. 2013;10(3):89-90.
Upadhyaya A, Hu T, Meng Z, Li X, He X, Tian W, et al. Harmonic versus LigaSure hemostasis technique in thyroid surgery: A meta-analysis. Biomed Rep. 2016;5(2):221-7.
Papavramidis TS, Sapalidis K, Michalopoulos N, Triantafillopoulou K, Gkoutzamanis G, Kesisoglou I, et al. UltraCision harmonic scalpel versus clamp-and-tie total thyroidectomy: a clinical trial. Head Neck. 2010;32(6):723-7.
Ruggiero R, Procaccini E, Piazza P, Docimo G, Iovino F, Antoniol G, et al. Effectiveness of fibrin glue in conjunction with collagen patches to reduce seroma formation after axillary lymphadenectomy for breast cancer. Am J Surg. 2008;196(2):170-4.
Ruggiero R, Procaccini E, Gili S, Cremone C, Parmeggiani D, Conzo G, et al. New trends on fibrin glue in seroma after axillary lymphadenectomy for breast cancer. G Chir. 2009;30(6-7):306-10.
Foreman E, Aspinall S, Bliss RD, Lennard TW. The use of the harmonic scalpel in thyroidectomy: 'beyond the learning curve'. Ann R Coll Surg Engl. 2009;91(3):214-6.
Lenihan J, Kovanda C, Commerano C. Comparison of laparoscopic-assisted vaginal hysterectomy with traditional hysterectomy for cost- effectiveness to employers. Am J Obstet Gynecol. 2004;190(6):1714-22.
Cannizzaro MA, Lo Bianco S, Borzì L, Cavallaro A, Buffone A. The use of FOCUS Harmonic scalpel compared to conventional haemostasis (knot and tie ligation) for thyroid surgery: a prospective randomized study. Springerplus. 2014;3:639.
Al-Dhahiry JK, Hameed HM. Total thyroidectomy: Conventional Suture Ligation technique versus sutureless techniques using Harmonic Scalpel or Maxium. Ann Med Surg (Lond). 2015;5:29-34.
Ruggiero R, Gubitosi A, Conzo G, Gili S, Bosco A, Pirozzi R, et al. Sutureless thyroidectomy. Int J Surg. 2014;12(1):S189-93.
Bove A, Ppanikolaou I, Bongarzoni G, Mattei P, Markogiannakis H, Chatzipetrou M, et al. Thyroid surgery with harmonic focus, Ligasure precise and conventional technique: a retrospective case-matched study. Hippokratia. 2012;16(2):154-9.
Nenkov R, Radev R, Marinova E, Cvetkov N, Semkov A, Petrov B. The harmonic scalpel application in thyroid surgery. J IMAB. 2013;19(1):408-11.
Sista F, Schietroma M, Ruscitti C, De Santis G, De Vita F, Carlei F, et al. New ultrasonic dissector versus conventional hemostasis in thyroid surgery: a randomized prospective study. J Laparoendosc Adv Surg Tech A. 2012;22(3):220-4.
Calò PG, Pisano G, Medas F, Tatti A, Tuveri M, Nicolosi A. The use of the harmonic scalpel in thyroid surgery. Our experience. Ann Ital Chir. 2012;83(1):7-12.
Basoglu M, Ozturk G, Atamanalp SS, Aydinli B, Yildirgan MI, Oren D. The use of harmonic scalpels in thyroidectomies: clinical experiences. Eurasian J Med. 2008;40(2):75-8.
Zanghi A, Cavallaro A, Di Vita M, Cardi F, Di Mattia P, Piccolo G, et al. The safety of the Harmonic Focus in open thyroidectomy: a prospective, randomized study comparing the Harmonic Focus and traditional suture ligation (knot and tie) technique. Int J Surg. 2014;12(1):S132-5.
Docimo G, Ruggiero R, Gubitosi A, Casalino G, Bosco A, Gili S. Ultrasound scalpel in thyroidectomy. Prospective randomized study. Ann. Ital. Chir. 2012;83(6):491-6.
Ferri E, Armato E, Spinato G, Spinato R. Focus harmonic scalpel compared to conventional haemostasis in open total thyroidectomy: a prospective randomized trial. Int J Otolaryngol. 2011;2011:357195.
Revelli L, Damiani G, Bianchi CB, Vanella S, Ricciardi W, Raffaelli M, et al. Complications in thyroid surgery. Harmonic Scalpel, Harmonic Focus versus Conventional Hemostasis: A meta-analysis. Int J Surg. 2016;28(1):S22-32.
Ecker T, Carvalho 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(1):17-25.
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(6):736-40.
Materazzi G, Dionigi G, Berti P, Rago R, Frustaci G, Docimo G. One- day thyroid surgery: retrospective analysis of safety and patient satisfaction on a consecutive series of 1.571 cases over a three ∼year period. Eur Surg Res. 2007;39(3):182-8.
Cocchiara G, Cajozzo M, Amato G, Mularo A, Agrusa A, Romano G. Terminal ligature of inferior thyroid artery branches during total thyroidectomy for multinodular goiter is associated with higher postoperative calcium and PTH levels. J Visc Surg. 2010;147(5):329-32.
Yildirim O, Umit T, Ebru M, Bulent U, Belma K, Betul B, Mete D, Omer C. Ultrasonic harmonic scalpel in total thyroidectomies. Adv Ther. 2008;25(3):260-5.
Back K, Hur N, Choe J, Kim J, Kim J. A Prospective, Randomized, Controlled Comparative Study of Three Energy Devices in OpenThyroid Surgery: Thunderbeat, Harmonic, and Ligasure. J Endocrine Surgy. 2019;19(4):106-15.