title: The use of the harmonic scalpel vs conventional knot tying for vessel ligation in thyroid surgery.
abstract: OBJECTIVE
  The technique of thyroidectomy has undergone little change in several decades. The harmonic scalpel, using ultrasonic frictional heating to ligate vessels, is widely used in laparoscopic surgery, but there is little experience in open thyroidectomy. We hypothesized that the use of the harmonic scalpel could lead to a significant reduction in operative time as compared with knot tying in thyroid surgery.
  
  
  METHODS
  Retrospective case-controlled study.
  
  
  METHODS
  Teaching institution.
  
  
  METHODS
  One hundred seventy-one consecutive patients undergoing lobectomy or total thyroidectomy by one surgeon (A.E.S.).
  
  
  METHODS
  Eighty-six patients underwent thyroid surgery with the conventional clamp-and-tie technique (lobectomy, n = 49; total thyroidectomy, n = 36) and 85 with the harmonic scalpel (lobectomy, n = 38; total thyroidectomy, n = 47).
  
  
  METHODS
  Demographics, pathological characteristics, thyroid size, operative time, blood loss, and complications using a 2-tailed t test, chi(2)test, and Wilcoxon rank sum test.
  
  
  RESULTS
  The 2 groups were similar regarding age and sex. There were no intraoperative complications. Mean +/- SD thyroid size tended to be larger in the harmonic scalpel group for both lobectomy (5.1 +/- 2.6 cm vs 4.2 +/- 2.2 cm; P =.06) and total thyroidectomy specimens (6.3 +/- 3.8 cm vs 4.8 +/- 2.9 cm; P =.08) compared with the conventional technique. Mean +/- SD operative time was shorter in the harmonic scalpel group compared with the conventional technique group for both lobectomy (89 +/- 20 minutes vs 115 +/- 25 minutes; P<.01) and total thyroidectomy (132 +/- 39 minutes vs 161 +/- 42 minutes; P<.01) procedures. There was no difference between the 2 techniques regarding the amount of blood loss for different procedures. There was no effect of tumor size on operative time (Pearson correlation factors: 0.14 for total, 0.21 for unilateral thyroidectomy).
  
  
  CONCLUSIONS
  The use of the harmonic scalpel for the control of thyroid vessels during thyroid surgery is safe, and it shortens the operative time by almost 30 minutes compared with the conventional technique for both unilateral lobectomy or total thyroidectomy procedures.
authors.affiliation: Department of General Surgery, the Cleveland Clinic Foundation, 9500 Euclid Ave, Desk A80, Cleveland, OH 44195, USA. sipersa@ccf.org
authors.forename: Allan E
authors.initials: AE
authors.lastname: Siperstein
authors.forename: Eren
authors.initials: E
authors.lastname: Berber
authors.forename: Ebru
authors.initials: E
authors.lastname: Morkoyun
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D004564:Electrocoagulation / Q000295:instrumentation*; D005260:Female; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D008026:Ligation / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013525:Surgical Instruments; D013965:Thyroidectomy / Q000295:instrumentation*; D016896:Treatment Outcome; D014465:Ultrasonics