title: Complications in thyroid surgery. Harmonic Scalpel, Harmonic Focus versus Conventional Hemostasis: A meta-analysis.
abstract: BACKGROUND
  To evaluate the incidence of postoperative complications, hemostatic effects and safety of Total Thyroidectomy (TT) performed using the Harmonic Scalpel (HS), the Harmonic Focus (HF) or Conventional Hemostasis (CH).
  
  
  METHODS
  The meta-analysis was performed according to PRISMA guidelines. A literature search was conducted from 2003 to 2014 and stringent criteria were required for inclusion. Thirteen studies concerning an overall population of 1458 compared HS versus CH, whilst 8 studies with 1667 patients compared HF versus CH.
  
  
  RESULTS
  There was a significant reduction of operative time (Mean Difference [MD] = -25.49 min.; 95% CI -32.43 to -18.55), intraoperative blood loss (MD = -30.49 mL; 95% CI -53.01 to -7.97), postoperative drainage volume (MD = -12.90 mL; 95% CI -22.83 to -2.98) and postoperative pain (MD = -0.87; 95% CI -1.27 to -0.46) in patients underwent TT with HS. Regarding HF group, a significant reduction of operative time (MD = -25.99 min., 95% CI -34.56 to -17.41), length of hospital stay (MD = -0.57; 95% CI -0.97 to -0.17), transient hypocalcemia (OR = 0.56; 95% CI 0.39 to 0.81) and postoperative pain (MD = -1.33 days; 95% CI -2.49 to -0.17) resulted.
  
  
  CONCLUSIONS
  HS TT can be a safe, useful and fast alternative to conventional TT. The newer HF can reduce the rate of hypocalcemia. Future RCTs of larger patient cohorts with more detailed data of postoperative complications, cost-effectiveness and cosmetic results, randomization procedures, intention-to-treat analyses and blinding of outcome assessors are needed to draw more meaningful conclusions.
authors.affiliation: Department of Surgical Sciences, University Hospital Agostino Gemelli, Catholic University of Sacred Heart, Rome, Italy. Electronic address: luca.revelli@unicatt.it.
authors.forename: Luca
authors.initials: L
authors.lastname: Revelli
authors.affiliation: Department of Public Health, University Hospital Agostino Gemelli, Catholic University of Sacred Heart, Rome, Italy. Electronic address: gdamiani@rm.unicatt.it.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Damiani
authors.affiliation: Cooperative OSA Onlus, Associated Health Care Workers, Rome, Italy. Electronic address: caterinablanc@gmail.com.
authors.forename: Caterina Bianca Neve Aurora
authors.initials: CB
authors.lastname: Bianchi
authors.affiliation: Department of Surgical Sciences, University Hospital Agostino Gemelli, Catholic University of Sacred Heart, Rome, Italy. Electronic address: nekroma@yahoo.it.
authors.forename: Serafino
authors.initials: S
authors.lastname: Vanella
authors.affiliation: Department of Public Health, University Hospital Agostino Gemelli, Catholic University of Sacred Heart, Rome, Italy. Electronic address: wricciardi@rm.unicatt.it.
authors.forename: Walter
authors.initials: W
authors.lastname: Ricciardi
authors.affiliation: Department of Surgical Sciences, University Hospital Agostino Gemelli, Catholic University of Sacred Heart, Rome, Italy. Electronic address: marco.raffaelli@unicatt.it.
authors.forename: Marco
authors.initials: M
authors.lastname: Raffaelli
authors.affiliation: Department of Surgical Sciences, University Hospital Agostino Gemelli, Catholic University of Sacred Heart, Rome, Italy. Electronic address: celestinopio.lombardi@unicatt.it.
authors.forename: Celestino Pio
authors.initials: CP
authors.lastname: Lombardi
mesh_terms: D016063:Blood Loss, Surgical / Q000517:prevention & control*; D004322:Drainage; D005260:Female; D006488:Hemostasis, Surgical / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D007902:Length of Stay; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D011184:Postoperative Period; D013525:Surgical Instruments; D013961:Thyroid Gland / Q000601:surgery*; D013965:Thyroidectomy / Q000009:adverse effects* / Q000295:instrumentation* / Q000379:methods
keywords: Complications in thyroidectomy; Harmonic Focus; Harmonic Scalpel; Hemostasis; Thyroid; Thyroid surgery; Ultrasonic dissector; Ultrasonic scalpel