Harmonic scalpel in multinodular goiter surgery: impact on surgery and cost analysis.
BACKGROUND
The aim of this study was to evaluate the potential advantages and the general operative cost of the Harmonic Scalpel (HS) in surgery for multinodular goiter (MNG).


METHODS
Patients undergoing total thyroidectomy (TT) for MNG were prospectively allocated in a conventional tie-and-clip (TC) group (n = 50) and an HS group (n = 50). All pre- and postoperative data were recorded. The economic evaluation was based on a microcost measurement and aimed to consider all the resources consumed for each patient during the surgical procedure. To compare the results, we used the nonparametric unpaired two-tailed Mann-Whitney test.


RESULTS
There were 81 women and 19 men (mean age, 55 +/- 15 years). Mean preoperative TSH level was 1.2 (SD, 1.1) (TC) and 1.3 (SD, 2) (HS) (P = NS). Mean body mass index was 24.72 (SD, 8) (TC) and 25.6 (SD, 8) (HS) (P = NS). Four patients experienced a transient hypocalcemia (2 in each group). One patient had a postoperative hematoma requiring surgical evacuation (HS). One patient experienced a transient recurrent nerve palsy (TC). Mean length of surgery was 104 (SD, 32) (TC) and 84 minutes (SD, 17) (HS) (P = .0001). Mean length of hospitalization was 2 days in both groups (SD, 1) (P = NS). Mean operative cost per patient was 990 euro (SD, 191) in the TC group and 1,024 euro (SD, 143) in the HS group (P = NS).


CONCLUSIONS
Safety and efficiency of the HS is comparable to the tie-and-clip technique in thyroid surgery. The use of the HS in MNG surgery allows for a significant reduction in the length of the procedure with a comparable cost.
Sebag
Frederic
F
Department of General and Endocrine Surgery, Hôpital de La Timone, Marseille, France. frederic.sebag@ap-hm.fr
Fortanier
Cécile
C
Ippolito
Guiseppe
G
Lagier
Aude
A
Auquier
Pascal
P
Henry
Jean-Francois
JF
D015992:Body Mass Index; D003365:Costs and Cost Analysis; D005260:Female; D006042:Goiter / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D013525:Surgical Instruments / Q000191:economics*; D013965:Thyroidectomy / Q000191:economics / Q000295:instrumentation*; D016896:Treatment Outcome; D014465:Ultrasonics