Minimally invasive video-assisted thyreoidectomy (MIVAT) with and without use of harmonic scalpel--a randomized study.
OBJECTIVE
Minimally invasive video-assisted thyroidectomy (MIVAT) has been used for the removal of small thyroid nodules to improve cosmetic results and diminish pain. The aim of this study was to compare the outcomes of the MIVAT operations with and without the use of an ultrasonic harmonic scalpel (HS).


METHODS
Seventy-six patients with a solitary thyroid nodule below 30 mm in diameter were randomized to two groups of 38 patients each. Unilateral thyroid lobectomy was performed in each patient. In the clip-ligation group (CL-G), during MIVAT, the superior thyroid vessels were clipped and bipolar coagulation was used to secure smaller vessels, whereas in the harmonic scalpel group (HS-G), HS was used to dissect and divide all the thyroid vessels. The statistical analysis included the mean operative time, blood loss, postoperative morbidity, scar length, cosmetic satisfaction at 1 and 6 months following surgery, and cost-effectiveness.


RESULTS
HS-G vs CL-G operations were shorter (31.4 +/- 7.7 vs 47.5 +/- 13.2 min; p < 0.001), the mean blood loss was smaller (12.9 +/- 5.7 vs 32.8 +/- 13.0 ml; p < 0.001), the mean scar length at 1 month following surgery was shorter (15.6 +/- 1.4 vs 21.5 +/- 1.9 mm; p < 0.001), and greater cosmetic satisfaction was achieved at 1 month after surgery (88.9 +/- 9.7 vs 81.9 +/- 5.4 pts; p < 0.001), but the difference became nonsignificant at 6 months postoperatively. MIVAT with HS was 20-30 euros more expensive. No major complications were observed in both groups.


CONCLUSIONS
HS in the MIVAT operations is safe and facilitates dissection, allowing for a significant decrease in operative time. Other benefits, such as lower blood loss, a scar a few millimeters shorter, or a slightly better early cosmetic result, are offered at slightly increased costs.
Barczyński
Marcin
M
Department of Endocrine Surgery, 3rd Chair of General Surgery, Jagiellonian University College of Medicine, 37 Pradnicka Street, 31-202, Kraków, Poland. marbar@mp.pl
Konturek
Aleksander
A
Cichoń
Stanisław
S
D018263:Adenocarcinoma, Follicular / Q000000981:diagnostic imaging / Q000601:surgery; D000328:Adult; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006488:Hemostasis, Surgical / Q000295:instrumentation; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation*; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000209:etiology; D013525:Surgical Instruments; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D016606:Thyroid Nodule / Q000000981:diagnostic imaging / Q000601:surgery*; D013965:Thyroidectomy / Q000295:instrumentation*; D014464:Ultrasonic Therapy / Q000295:instrumentation*; D014463:Ultrasonography; D020535:Video-Assisted Surgery / Q000295:instrumentation*