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A Comparison of Harmonic Scalpel and Conventional Techniques for Thyroidectomy

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Indian Journal of Otolaryngology and Head & Neck Surgery Aims and scope Submit manuscript

Abstract

Thyroidectomy is one of the most frequently performed surgeries. Conventional techniques using electrocautery carry the risk of tissue injury. Recently, there has been increased use of harmonic scalpels in thyroid surgery. The harmonic scalpel utilizes ultrasonic shears for cutting and coagulation, thus minimizing thermal injury. The objective of our study was to determine differences in operative duration, hypocalcemia, and RLN palsy. This single-center retrospective comparative study included consecutive patients undergoing hemithyroidectomies using the harmonic scalpel and conventional technique in the past one year (n = 64, harmonic group = 28 and conventional group = 36). The mean operative duration for the harmonic scalpel group was 70.4 min, vs. 81.31 min for the conventional technique group, and the difference in mean duration was found to be 10.84 min (p = 0.027). There was no statistically significant difference in the rates of hypocalcemia (p = 0.751) or RLN palsy (p = 0.121). None of the patients in either group developed permanent hypocalcemia or RLN palsy. The use of a harmonic scalpel during thyroidectomy is safe. The overall surgical duration was reduced when the harmonic scalpel was used, and the complication rates were comparable to those of the conventional technique, making it a non-inferior technique for surgical intervention in thyroidectomy and warranting harmonic scalpel consideration as a valuable addition to the armamentarium of thyroid surgeons.

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References

  1. Hannan SA (2006) The magnificent seven: a history of modern thyroid surgery. Int J Surg Lond Engl 4(3):187–191

    Article  Google Scholar 

  2. Manouras A, Markogiannakis H, Koutras AS, Antonakis PT, Drimousis P, Lagoudianakis EE et al (2008) Thyroid surgery: comparison between the electrothermal bipolar vessel sealing system, harmonic scalpel, and classic suture ligation. Am J Surg 195(1):48–52

    Article  PubMed  Google Scholar 

  3. Voutilainen PE, Haglund CH (2000) Ultrasonically activated shears in thyroidectomies: a randomized trial. Ann Surg 231(3):322–328

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Siperstein AE (2002) The use of the harmonic scalpel versus conventional knot tying for vessel ligation in thyroid surgery. Arch Surg 137(2):137

    Article  PubMed  Google Scholar 

  5. Stack BC, Bimston DN, Bodenner DL, Brett EM, Dralle H, Orloff LA et al (2015) American association of clinical endocrinologists and American college of endocrinology disease state clinical review: postoperative hypoparathyroidism-definitions and management. Endocr Pract 21(6):674–685

    Article  PubMed  Google Scholar 

  6. Amaral JF (1994) The experimental development of an ultrasonically activated scalpel for laparoscopic use. Surg Laparosc Endosc 4(2):92–99

    CAS  PubMed  Google Scholar 

  7. Amaral JF (1995) Laparoscopic cholecystectomy in 200 consecutive patients using an ultrasonically activated scalpel. Surg Laparosc Endosc 5(4):255–262

    CAS  PubMed  Google Scholar 

  8. Revelli L, Damiani G, Bianchi CBNA, Vanella S, Ricciardi W, Raffaelli M et al (2016) Complications in thyroid surgery. Harmonic scalpel, harmonic focus versus conventional hemostasis: a meta-analysis. Int J Surg 28:S22-32

    Article  PubMed  Google Scholar 

  9. Kandil E, Krishnan B, Noureldine SI, Yao L, Tufano RP (2013) Hemithyroidectomy: a meta-analysis of postoperative need for hormone replacement and complications. ORL J Oto-Rhino-Laryngol Relat Spec 75(1):6–17

    Article  CAS  Google Scholar 

  10. Page C, Strunski V (2007) Parathyroid risk in total thyroidectomy for bilateral, benign, multinodular goitre: report of 351 surgical cases. J Laryngol Otol 121(3):237–241

    Article  CAS  PubMed  Google Scholar 

  11. Rosato L, Avenia N, Bernante P, De Palma M, Gulino G, Nasi PG et al (2004) Complications of thyroid surgery: analysis of a multicentric study on 14,934 patients operated on in Italy over 5 years. World J Surg 28(3):271–276

    Article  PubMed  Google Scholar 

  12. Sasson AR, Pingpank JJF, Wetherington RW, Hanlon AL, Ridge JA (2001) Incidental parathyroidectomy during thyroid surgery does not cause transient symptomatic hypocalcemia. Arch Otolaryngol Neck Surg 127(3):304–308

    Article  CAS  Google Scholar 

  13. Pattou F, Combemale F, Fabre S, Carnaille B, Decoulx M, Wemeau JL et al (1998) Hypocalcemia following thyroid surgery: incidence and prediction of outcome. World J Surg 22(7):718–724

    Article  CAS  PubMed  Google Scholar 

  14. Del Rio P, Rossini M, Montana CM, Viani L, Pedrazzi G, Loderer T et al (2019) Postoperative hypocalcemia: analysis of factors influencing early hypocalcemia development following thyroid surgery. BMC Surg 18(1):25

    PubMed  PubMed Central  Google Scholar 

  15. Kalyoncu D, Gonullu D, Gedik ML, Er M, Kuroglu E, Igdem AA et al (2014) Analysis of the factors that have an effect on hypocalcemia following thyroidectomy. Turk J Surg 29(4):171–176

    Article  Google Scholar 

  16. Butskiy O, Chang BA, Luu K, McKenzie RM, Anderson DW (2018) A systematic approach to the recurrent laryngeal nerve dissection at the cricothyroid junction. J Otolaryngol-Head Neck Surg J Oto-Rhino-Laryngol Chir Cervico-Faciale 47(1):57

    Article  Google Scholar 

  17. Emam TA, Cuschieri A (2003) How safe is high-power ultrasonic dissection? Ann Surg 237(2):186–191

    Article  PubMed  PubMed Central  Google Scholar 

  18. Družijanić N, Pogorelić Z, Perko Z, Mrklić I, Tomić S (2012) Comparison of lateral thermal damage of the human peritoneum using monopolar diathermy, harmonic scalpel and LigaSure. Can J Surg 55(5):317–321

    Article  PubMed  PubMed Central  Google Scholar 

  19. Applewhite MK, White MG, James BC, Abdulrasool L, Kaplan EL, Angelos P et al (2017) Ultrasonic, bipolar, and integrated energy devices: comparing heat spread in collateral tissues. J Surg Res 207:249–254

    Article  PubMed  Google Scholar 

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No funding was received to assist with the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Otolaryngology and Head Neck Surgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India

    Ripu Daman Arora & A. P. Abishek

  2. Department of Head and Neck Oncology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India

    S. D. Prajwal, Karthik Nagaraja Rao & Ambesh Singh

  3. All India Institute of Medical Sciences, Raipur, Chhattisgarh, India

    Nitin M. Nagarkar

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  1. Ripu Daman Arora
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  2. S. D. Prajwal
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  3. Karthik Nagaraja Rao
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  4. Ambesh Singh
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  5. Nitin M. Nagarkar
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  6. A. P. Abishek
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Contributions

PD and RDA: Concept, Design, Literature search, Writing; PD and KNR: Concept, Analysis and/or interpretation; PD and KNR: Analysis and/or interpretation; PD, KNR, AS and AAP: Literature search, Writing; NMN and RDA: Supervision, Critical review.

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Correspondence to S. D. Prajwal.

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Authors are having no financial interests that are directly or indirectly related to the work submitted for publication.

Human and Animal Rights

The research involved human Participants, and well-informed consent was taken from each individual. The exemption from the ethical committee review was obtained in view of the retrospective study (Letter no: 2848/IEC-AIIMSRPR/2023).

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Arora, R.D., Prajwal, S.D., Rao, K.N. et al. A Comparison of Harmonic Scalpel and Conventional Techniques for Thyroidectomy. Indian J Otolaryngol Head Neck Surg 75, 3410–3414 (2023). https://doi.org/10.1007/s12070-023-04002-x

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