[Minimally invasive open thyroid resections with harmonic scalpel].
The harmonic scalpel has been widely used in the field of thyroid surgery in recent years.


OBJECTIVE
To present our initial results after the introduction of harmonic scalpel use during thyroid resections with minimally invasive open approach.


METHODS
For the period from 01 January to 31 June 2008, 158 thyroid resections using harmonic scalpel have been done in our institution. In 73 of these procedures minimally invasive open approach has been used (69 females and 4 males, at the age of 18 to 54 years, mean age 34.3 years). Patients have been directed to the group with minimally invasive open approach on the ground of inclusion criteria and indications for minimally invasive surgery adopted in our institution. The size of the dominant nodule in multinodular goiters was less than 3.5 cm. In 38 (52%) patients with suspicious malignancy FNAB has been performed. In all procedures a central neck operative approach has been used with length of the incision between 2 and 3 cm (measured in the beginning and at the end of the procedure as well as on the 4th postoperative day). Thyroid resections have been performed using harmonic scalpel (Ethicon Inc.). The extent of thyroid resection, the amount of hemostatic instruments and ligatures, the number of drainages used during the procedures, as well as operative time and incidence of intra- and postoperative complications have been examined.


RESULTS
In 8 patients subtotal unilateral thyroid resections have been performed, 42 patients underwent lobectomy, 5 patients--subtotal bilateral thyroid resection and 18 patients--thyroidectomy. The extent of surgery was: isthmusectomy with unilateral partial thyroid resection in 11 patients, isthmusectomy with bilateral partial thyroid resection in 8 patients, isthmusectomy with subtotal unilateral thyroid resection in 29 patients, lobectomy in 24 patients, subtotal bilateral thyroid resection in 17 patients and thyroidectomy in 18 patients. No hemostatic instruments for catching thyroid tissue and vessels, nor following suture ligatures have been used. Incision length reduction, absence of bleeding and shortened operative time have been observed. The reliable and steady hemostasis made the use of hemostatic instruments and stitches unnecessary. Regardless of the extent of surgery, the resections finished without draining.


CONCLUSIONS
We have found the harmonic scalpel to be extremely effective device, giving possibility for widespread of minimally invasive thyroid resections with open approach.
Nenkov
R
R
Radev
R
R
Madjov
R
R
Ignatov
I
I
D000293:Adolescent; D000328:Adult; D005260:Female; D006488:Hemostasis, Surgical; D006801:Humans; D008297:Male; D008875:Middle Aged; D013961:Thyroid Gland / Q000601:surgery*; D013965:Thyroidectomy / Q000295:instrumentation* / Q000379:methods*; D055815:Young Adult