title: The use of a harmonic scalpel in thyroid surgery: report of a 3-year experience.
abstract: BACKGROUND
  Hemostasis in thyroid surgery is of utmost importance for a successful surgery and an uneventful postoperative course. The present article reports a single surgeon's 3-year experience in the use of the harmonic scalpel. The device was developed in the early 1990s and offered adequate and safe hemostasis for vessels up to 3 mm in width.
  
  
  METHODS
  This was a prospective observational study. Data sheets from all patients who had surgery by a single endocrine surgeon in the period from 1999 to 2004 were evaluated. Patients were divided into 3 groups based on the surgical technique used: group I comprised the conventional knot-and-tie technique, group II comprised the ligation of all but the superior thyroid vessels with a scalpel, and group III comprised patients in whom the device was used exclusively. The groups were compared in regard to surgical time, cost, and complication rate.
  
  
  RESULTS
  A total of 272 patients were included in the study: 107 patients were included in group I, 77 in group II, and 88 group III. The surgical time of group I differed significantly compared with groups II and III (P < .0001 in both cases). Surgical times between groups II and III did not differ significantly (P = .701).
  
  
  CONCLUSIONS
  The use of the harmonic scalpel reduces surgical time, but it increases the cost of the surgery. It is our belief that by including in the absolute cost the time saved and the reduction in human resources needed, the use of the scalpel would prove to be economic.
authors.affiliation: Department of Endocrine Surgery, First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocratio Hospital, Athens, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Koutsoumanis
authors.forename: Athanasios S
authors.initials: AS
authors.lastname: Koutras
authors.forename: Panagiotis G
authors.initials: PG
authors.lastname: Drimousis
authors.forename: Konstantinos M
authors.initials: KM
authors.lastname: Stamou
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Theodorou
authors.forename: Stylianos
authors.initials: S
authors.lastname: Katsaragakis
authors.forename: John
authors.initials: J
authors.lastname: Bramis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D017558:Elective Surgical Procedures; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006488:Hemostasis, Surgical / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013959:Thyroid Diseases / Q000601:surgery*; D013965:Thyroidectomy / Q000295:instrumentation*; D016896:Treatment Outcome