title: Total thyroidectomy with harmonic scalpel combined to gelatin-thrombin matrix hemostatic agent: is it safe and effective? A single-center prospective study.
abstract: BACKGROUND
  Hemostasis during thyroidectomy is essential; however, the safest, most efficient and cost-effective way to achieve this is unclear. The aim of this study was to evaluate the outcome of total thyroidectomy (TT) performed with combination of harmonic scalpel (HS) and Floseal.
  
  
  METHODS
  Patients undergone TT were divided into two groups: HS + Floseal and traditional hemostasis groups. The primary endpoint was 24-h drain output and blood-loss requiring reintervention. Secondary endpoints included surgery duration, postsurgical complications and hypocalcemia rates.
  
  
  RESULTS
  Between September 2012 and January 2014, 165 patients were enrolled (100 to HS + Floseal, 65 to standard hemostasis); 80.5% female; mean age 42.3 years. The 24-h drain output was lower in the HS + Floseal group compared with standard TT. HS + Floseal also had a shorter mean surgery time (p < 0.0001) vs standard TT. No differences in post-surgical complications and in hypocalcemiarates between groups.
  
  
  CONCLUSIONS
  combination of Floseal plus the HS is effective and safe for TT and it provides a complementary hemostatic approach.
authors.affiliation: Department of General Surgery, Second University of Naples, Via Pansini 5, 80131 Naples, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Docimo
authors.affiliation: Department of General Surgery, Second University of Naples, Via Pansini 5, 80131 Naples, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Tolone
authors.affiliation: Department of General Surgery, Second University of Naples, Via Pansini 5, 80131 Naples, Italy. Electronic address: roberto.ruggiero@unina2.it.
authors.forename: Roberto
authors.initials: R
authors.lastname: Ruggiero
authors.affiliation: Department of General Surgery, Second University of Naples, Via Pansini 5, 80131 Naples, Italy.
authors.forename: Gianmattia
authors.initials: G
authors.lastname: del Genio
authors.affiliation: Department of General Surgery, Second University of Naples, Via Pansini 5, 80131 Naples, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Brusciano
authors.affiliation: Surgical Unit, University of Bari, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: Pezzolla
authors.affiliation: Department of General Surgery, Second University of Naples, Via Pansini 5, 80131 Naples, Italy.
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Jannelli
authors.affiliation: Department of General Surgery, Second University of Naples, Via Pansini 5, 80131 Naples, Italy.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Bosco
authors.affiliation: Department of General Surgery, Second University of Naples, Via Pansini 5, 80131 Naples, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Parmeggiani
authors.affiliation: Department of General Surgery, Second University of Naples, Via Pansini 5, 80131 Naples, Italy.
authors.forename: Cosmo
authors.initials: C
authors.lastname: Cosenza
authors.affiliation: Department of General Surgery, Second University of Naples, Via Pansini 5, 80131 Naples, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Limongelli
authors.affiliation: Department of General Surgery, Second University of Naples, Via Pansini 5, 80131 Naples, Italy.
authors.forename: Ludovico
authors.initials: L
authors.lastname: Docimo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D005781:Gelatin Sponge, Absorbable / Q000494:pharmacology*; D006488:Hemostasis, Surgical / Q000295:instrumentation*; D006490:Hemostatics / Q000494:pharmacology; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D011446:Prospective Studies; D013917:Thrombin / Q000494:pharmacology*; D013965:Thyroidectomy / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: C411004:FloSeal Matrix; D006490:Hemostatics; D013917:Thrombin
keywords: Floseal; Gelatin-thrombin matrix topical hemostatic agent; Harmonic scalpel; Total thyroidectomy