Use of the harmonic scalpel versus conventional haemostatic techniques in patients with Grave disease undergoing total thyroidectomy: a prospective randomised controlled trial.
BACKGROUND
Thyrotoxicosis is often considered to be the most difficult thyroid operation because of the high vascularisation and the risk of bleeding. The conventional haemostatic technique in thyroidectomy today include knot tying and electrocoagulation. The introduction of the harmonic scalpel (HS) has led to further research if the use of the HS has any benefits in thyroid surgery. To our knowledge, no previous study has evaluated the HS dissection technique in a homogenous group of patients with Graves' disease undergoing total thyroidectomy.


METHODS
Fifty-one patients (39 women and 12 men) with the pre-operative diagnosis of Graves' disease treated at two endocrine centers were randomised to total thyroidectomy with the use of the HS or with conventional haemostatic techniques.


RESULTS
Twenty-seven patients were randomised to the harmonic group and 24 to the conventional group. The operating time was shorter in the HS group (median, 121 min; range, 84-213 min) compared to the conventional group (median, 172 min; range, 66-268 min; p = 0.011).


CONCLUSIONS
The use of the HS was associated with a significant reduction in operating time compared to the use of the conventional haemostatic techniques in patients with Graves' disease undergoing total thyroidectomy.
Hallgrimsson
P
P
Department of Surgery, Lund University Hospital, Lund, Scania, Sweden. Pall.hallgrimsson@med.lu.se
Lovén
L
L
Westerdahl
J
J
Bergenfelz
Anders
A
D000328:Adult; D000368:Aged; D003365:Costs and Cost Analysis; D004526:Efficiency; D005260:Female; D005500:Follow-Up Studies; D006111:Graves Disease / Q000601:surgery*; D006488:Hemostasis, Surgical / Q000191:economics / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D013525:Surgical Instruments / Q000191:economics; D013548:Sweden; D013965:Thyroidectomy / Q000191:economics / Q000295:instrumentation*; D014464:Ultrasonic Therapy / Q000191:economics / Q000295:instrumentation*; D055815:Young Adult