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01-09-2008 | Current Concepts in Endocrine Surgery

The use of “harmonic scalpel” versus “knot tying” for conventional “open” thyroidectomy: results of a prospective randomized study

Authors: Celestino Pio Lombardi, Marco Raffaelli, Americo Cicchetti, Marco Marchetti, Carmela De Crea, Rossella Di Bidino, Luigi Oragano, Rocco Bellantone

Published in: Langenbeck's Archives of Surgery | Issue 5/2008

Abstract

Purpose

We evaluated the safety and cost-effectiveness of the harmonic scalpel (HS) during conventional “open” thyroidectomy (CT).

Materials and methods

Two hundred patients scheduled for conventional total thyroidectomy (TT) were included in the study and randomly assigned to TT with the use of HS (HS group) or with knot tying technique (KT group).

Results

Mean operative time was significantly shorter in the HS group (P < 0.001), as well as the total operative room occupation time (P < 0.001). The cost of the disposable materials is significantly higher in the HS group (420.1 ± 23.2 vs 137.8 ± 25.3 euros; P < 0.001). Conversely, drugs, personnel and operative room charges were significantly higher in KT group patients (P < 0.001). Overall, no significant difference was found between the two groups concerning the charges of the hospitalisation (P = NS).

Conclusions

HS is a safe alternative to KT, allowing for a significant reduction of operative time without increasing complications rate and overall costs and probably better utilization of health resources.

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Duh QY (2003) Minimally invasive endocrine surgery: standard of treatment or hype? Surgery 134:849–857 doi:10.1016/S0039-6060(03)00405-7 PubMedCrossRef

Duh QY (2005) What’s new in general surgery: endocrine surgery. J Am Coll Surg 201:746–753 doi:10.1016/j.jamcollsurg.2005.07.007 PubMedCrossRef

Martin RR, Sbar A (2002) Regional anaesthesia and thyroidectomy: local anaesthesia for thyroidectomy. Curr Surg 59:517–520 doi:10.1016/S0149-7944(02)00691-8 PubMedCrossRef

Meurisse M, Defechereux T, Maweja S, Degauque C, Vandelaer M, Hamoir E (2000) Evaluation de l’utilisation du dissecteur ultrasonique Ultracision en chirurgie thyroïdienne. Etude prospective randomisée. Ann Chir 125:468–472 doi:10.1016/S0003-3944(00)00223-6 PubMedCrossRef

Voutilainen PE, Haglund CH (2000) Ultrasonically activated shears in thyroidectomies. A randomised trial. Ann Surg 231:322–328 doi:10.1097/00000658-200003000-00004 PubMedCrossRef

Siperstein A, Berber E, Morkoyun E (2002) The use of the harmonic scalpel vs conventional knot tying for vessel ligation in thyroid surgery. Arch Surg 137:137–142 doi:10.1001/archsurg.137.2.137 PubMedCrossRef

Shemen L (2002) Thyroidectomy using the harmonic scalpel: analysis of 105 consecutive cases. Otolaryngol Head Neck Surg 127:284–288 doi:10.1067/mhn.2002.128072 PubMedCrossRef

Ortega J, Sala C, Flor B, Lledo S (2004) Efficacy and Cost-Effectiveness of the UltraCision harmonic scalpel in thyroid surgery: an analysis of 200 cases in a randomised trial. J Laparoendosc Adv Surg Tech A 14(1):9–12 doi:10.1089/109264204322862289 PubMedCrossRef

Miccoli P, Berti P, Raffaelli M, Materazzi G, Conte M, Galleri D (2002) Impact of the harmonic scalpel on the operation time during video-assisted thyroidectomy. Surg Endosc 16:663–666 doi:10.1007/s00464-001-9117-3 PubMedCrossRef

10.

Cordón C, Fajardo R, Ramírez J, Herrera MF (2005) A randomised, prospective, parallel group study comparing the harmonic scalpel to electrocautery in thyroidectomy. Surgery 137:337–341 doi:10.1016/j.surg.2004.09.011 PubMedCrossRef

11.

Terris DJ, Seybt MW, Gourin CG, Chin E (2006) Ultrasonic technology facilitates minimal thyroid surgery. Laryngoscope 116:851–854 doi:10.1097/01.MLG.0000215831.66371.C4 PubMedCrossRef

12.

Miccoli P, Berti P, Dionigi Gian L, D’Agostino J, Orlandini C, Donatini G (2006) Randomized controlled trial of harmonic scalpel use during thyroidectomy. Arch Otolaryngol Head Neck Surg 132:1069–1073 doi:10.1001/archotol.132.10.1069 PubMedCrossRef

13.

Koutsoumanis K, Koutras AS, Drimousis PG, Stamou KM, Theodorou D, Katsaragakis S et al (2007) The use of a harmonic scalpel in thyroid surgery: report of a 3-year experience. Am J Surg 193:693–696 doi:10.1016/j.amjsurg.2006.06.049 PubMedCrossRef

14.

Petrakis I, Kogerakis NE, Lasithiotakis KG, Vrachassotakis N, Chalkiadakis GE (2004) Ligasure versus clamp-and-tie thyroidectomy for benign nodular disease. Head Neck 26:903–909 doi:10.1002/hed.20073 PubMedCrossRef

15.

Kiriakopoulos A, Tsakayannis D, Linos D (2004) Use of a diathermy system in thyroid surgery. Arch Surg 139:997–1000 doi:10.1001/archsurg.139.9.997 PubMedCrossRef

16.

Shen WT, Baumbusch MA, Kebebew E, Duh QY (2005) Use of the electrothermal vessel sealing system versus standard vessel ligation in thyroidectomy. Asian J Surg 28:86–89PubMed

17.

Lachanas VA, Prokopakis EP, Mpenakis AA, Karatzanis AD, Velegrakis GA (2005) The use of ligasure vessel sealing system in thyroid surgery. Otolaryngol Head Neck Surg 132:487–489 doi:10.1016/j.otohns.2004.09.020 PubMedCrossRef

18.

Kirdak T, Korun N, Ozguc H (2005) Use of ligasure in thyroidectomy procedures: results of a prospective comparative study. World J Surg 25:771–774 doi:10.1007/s00268-005-7788-y CrossRef

19.

Franko J, Kish KJ, Pezzi CM, Pak HO (2006) Safely increasing the efficiency of thyroidectomy using a new bipolar electrosealing device (Ligasure) versus conventional clamp-and-tie technique. Am Surg 72:132–136PubMed

20.

Bellantone R, Lombardi CP, Bossola M, Boscherini M, De Crea C, Alesina PF et al (2002) Total thyroidectomy for management of benign thyroid disease: a review of 526 cases. World J Surg 26:1468–1471 doi:10.1007/s00268-002-6426-1 PubMedCrossRef

21.

Viapiano J, Wards DS (2000) Operating room utilization: the need for data. Int Anesthesiol Clin 38:127–140 doi:10.1097/00004311-200010000-00009 PubMedCrossRef

Title: The use of “harmonic scalpel” versus “knot tying” for conventional “open” thyroidectomy: results of a prospective randomized study
Authors: Celestino Pio Lombardi
Marco Raffaelli
Americo Cicchetti
Marco Marchetti
Carmela De Crea
Rossella Di Bidino
Luigi Oragano
Rocco Bellantone
Publication date: 01-09-2008
Publisher: Springer-Verlag
Published in: Langenbeck's Archives of Surgery / Issue 5/2008
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-008-0380-9

At a glance: The STEP trials

Springer Medicine

The use of “harmonic scalpel” versus “knot tying” for conventional “open” thyroidectomy: results of a prospective randomized study

Abstract

Purpose

Materials and methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Materials and methods

Results

Conclusions

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