title: Clipless and sutureless endoscopic thyroidectomy using only the harmonic scalpel.
abstract: BACKGROUND
  The harmonic scalpel (HS) has been used in endoscopic thyroidectomy with encouraging results. However, additional instruments are frequently required to complete hemostasis. The current study aimed to assess the safety and efficacy of the clipless and sutureless technique using the HS in endoscopic thyroidectomy without supplementary instrumentation.
  
  
  METHODS
  A total of 114 patients underwent endoscopic hemithyroidectomy (HT) or total thyroidectomy (TT) via a unilateral axillo-breast approach. In all cases, hemostasis was achieved solely by the HS. Perioperative complications, surgery-related outcomes, and pathologic outcomes were examined.
  
  
  RESULTS
  The operating time in the TT group (170.23 +/- 45.63 min; n = 22) was longer than in the HT group (111.63 +/- 38.44 min; n = 92; p = 0.0000). After the first 50 cases, the operating time decreased significantly (145.60 +/- 52.72 min vs. 105.23 +/- 30.14 min, p = 0.0000). Postoperative minor hematomas from the skin flap were experienced by three patients (3.3%) in the HT group. No postoperative hemorrhage or hematoma was noted in the thyroidectomy field using the HS. Four patients in the HT group (4.3%) and one patient in the TT group (4.5%) experienced transient unilateral vocal cord palsy. Temporary hypocalcemia was observed in eight patients in the TT group (36.4%). No permanent recurrent laryngeal nerve palsy or hypoparathyroidism occurred in either group.
  
  
  CONCLUSIONS
  The HS alone in clipless and sutureless endoscopic thyroidectomy provides a good alternative to the conventional ligation or clipping technique because it is associated with a shorter operating time and a relatively low incidence of complications.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Bucheon, Korea.
authors.forename: Yoon Woo
authors.initials: YW
authors.lastname: Koh
authors.forename: Jae Hong
authors.initials: JH
authors.lastname: Park
authors.forename: Jae Wook
authors.initials: JW
authors.lastname: Kim
authors.forename: Seung Won
authors.initials: SW
authors.lastname: Lee
authors.forename: Eun Chang
authors.initials: EC
authors.lastname: Choi
mesh_terms: D000293:Adolescent; D000328:Adult; D000075202:Contraindications; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000517:prevention & control; D012189:Retrospective Studies; D013536:Suture Techniques; D013537:Sutures; D013959:Thyroid Diseases / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult