title: The use of the harmonic scalpel in thyroidectomy: 'beyond the learning curve'.
abstract: BACKGROUND
  Safe and effective haemostasis in surgery is clearly essential, and in the neck where risks of airway compromise are also present any new technology that purports to offer advantages must be rigorously evaluated. We describe our experience with the use of the Harmonic Scalpel [Ethicon UK] in thyroidectomy.
  
  
  METHODS
  A retrospective clinical review of 183 patients undergoing hemi or total thyroidectomies from 12 months prior to using the harmonic scalpel (2003; n = 77) and 12 months 'beyond the learning curve' (2006; n = 106).
  
  
  RESULTS
  The results demonstrate that, once past the learning curve, the use of the harmonic scalpel during thyroidectomy significantly reduces operative time and postoperative hypocalcaemia, and is as safe as conventional surgery with regard to voice change and bleeding.
  
  
  CONCLUSIONS
  The harmonic scalpel is as safe as conventional methods of haemostasis and operations using this technique are quicker once the need to have repetitive 'clip, cut and tie' routines is avoided.
authors.affiliation: Department of Endocrine Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
authors.forename: E
authors.initials: E
authors.lastname: Foreman
authors.forename: S
authors.initials: S
authors.lastname: Aspinall
authors.forename: R D
authors.initials: RD
authors.lastname: Bliss
authors.forename: T W J
authors.initials: TW
authors.lastname: Lennard