title: Total thyroidectomy: Conventional Suture Ligation technique versus sutureless techniques using Harmonic Scalpel or Maxium.
abstract: OBJECTIVE
  Harmonic Scalpel (HS) and Maxium (MAX) are surgical shears that enable simultaneous vessel sealing and tissue coagulation. This study compares the outcome of Total Thyroidectomy (TT) using Conventional Suture Ligation (CSL) technique versus (vs) two sutureless techniques; H S and MAX techniques in terms of safety, operative time, blood drainage volume, hospital stay and surgical complications.
  
  
  METHODS
  This is a prospective observational cohort study.
  
  
  METHODS
  This study was performed in AL-Karama Teaching Hospital/College of Medicine/University of Wasit/Iraq.
  
  
  METHODS
  This study was performed from June 2012 to 2015. A total of 80 patients, 60 patients were females and 20 patients were males (average/mean of age was 39/38 years). They underwent TT after been randomized into the following three groups: CSL group when Suture Ligation Technique was used, HS group when Harmonic Scalpel was used and MAX group when bipolar electrosurgery Maxium was used.
  
  
  RESULTS
  The postoperative evaluation of operative time, blood drainage volume and surgical complications revealed no statistically significant differences between HS group & MAX group, but there were statistically significant differences between CSL group vs. HS and MAX groups. Operative time statistics showed significant differences between CSL vs. HS and MAX groups, 113 ± 10.9 minutes (min), 93 ± 13 min and 92 ± 10.6 min respectively, p-value < 0.001 and 95% confidence interval [CI] (92.3712, 101.6288). The postoperative blood drainage volumes were significantly different between the three groups: CSL group = 150 ± 12.7 ml, HS group = 89 ± 16.21 ml and MAX group = 118 ± 9.6 ml, P-value = 0.046 and 95% [CI] (89.9932, 99.6068).
  
  
  CONCLUSIONS
  HS and MAX are safe, effective, and time-saving techniques. They are also associated with low blood loss and low complication rates. HS and MAX are good alternative techniques to CSL for thyroid surgery.
authors: Department of Surgery, AL-Karama Teaching Hospital, College of Medicine, Wasit University, Iraq.
authors: Jawad Kadhim S
authors: JK
authors: Al-Dhahiry
authors: Department of Surgery, AL-Karama Teaching Hospital, College of Medicine, Wasit University, Iraq.
authors: Husam Majeed
authors: HM
authors: Hameed
keywords: Conventional Suture Ligation; Harmonic Scalpel; Maxium; Thyroidectomy