title: Harmonic scalpel in multinodular goiter surgery: impact on surgery and cost analysis.
abstract: 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.
authors.affiliation: Department of General and Endocrine Surgery, Hôpital de La Timone, Marseille, France. frederic.sebag@ap-hm.fr
authors.forename: Frederic
authors.initials: F
authors.lastname: Sebag
authors.forename: Cécile
authors.initials: C
authors.lastname: Fortanier
authors.forename: Guiseppe
authors.initials: G
authors.lastname: Ippolito
authors.forename: Aude
authors.initials: A
authors.lastname: Lagier
authors.forename: Pascal
authors.initials: P
authors.lastname: Auquier
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Henry
mesh_terms: 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