title: Comparison of the harmonic focus and the thunderbeat for open thyroidectomy.
abstract: OBJECTIVE
  An effective method for controlling haemostasis during open thyroidectomy procedures is crucial because of the high risks of haemorrhage and neck haematoma. This study aimed to demonstrate the efficacy of the integrated ultrasonic/bipolar Thunderbeat™ for this procedure.
  
  
  METHODS
  This retrospective non-inferiority study compared the Thunderbeat™ and the ultrasonic Harmonic Focus® devices in 761 consecutive patients receiving a partial or total open thyroidectomy (with or without neck dissection). The main outcomes were duration of surgery, blood loss, and length of hospitalisation. Secondary outcomes were occurrence of hypocalcaemia, recurrent nerve paralysis, or other post-operative complications. A non-inferiority logistic regression approach was used to evaluate primary outcomes, adjusting for age, gender, body mass index, type of surgery, anaesthesiology score, and indication (benign or malign).
  
  
  RESULTS
  The data demonstrated that the Thunderbeat was non-inferior to the Focus in terms of duration of surgery, blood loss, and length of hospital stay. Furthermore, subgroup analyses showed non-inferiority of the Thunderbeat for partial thyroidectomy (all three outcomes), total thyroidectomy (duration of surgery and length of hospitalisation), and total thyroidectomy with neck dissection (length of hospitalisation). In terms of recurrent nerve paralysis and post-operative complications, the Thunderbeat performed at least as well as the Focus; however, no conclusions could be drawn regarding the occurrence of post-operative hypocalcaemia.
  
  
  CONCLUSIONS
  In a cohort of patients that underwent partial or total thyroidectomy, the Thunderbeat appeared to be at least as good as the Harmonic Focus.
authors.affiliation: Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Clinic Aalst, Moorselbaan 164, 9300, Aalst, Belgium. dr.samvanslycke@gmail.com.|Department of Head, Neck and Maxillofacial Surgery, University Hospital Ghent, De Pintelaan 185, 9000, Ghent, Belgium. dr.samvanslycke@gmail.com.
authors.forename: Sam
authors.initials: S
authors.lastname: Van Slycke
authors.affiliation: Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Clinic Aalst, Moorselbaan 164, 9300, Aalst, Belgium.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Gillardin
authors.affiliation: Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Clinic Aalst, Moorselbaan 164, 9300, Aalst, Belgium.
authors.forename: Klaas
authors.initials: K
authors.lastname: Van Den Heede
authors.affiliation: European Institute of Cancer Research, Carrer del Passeig 2, 08221, Terrassa, Barcelona, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Minguet
authors.affiliation: Department of Head, Neck and Maxillofacial Surgery, University Hospital Ghent, De Pintelaan 185, 9000, Ghent, Belgium.
authors.forename: Hubert
authors.initials: H
authors.lastname: Vermeersch
authors.affiliation: Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, Norra Stationsgatan 67, 17176, Stockholm, Sweden.
authors.forename: Nele
authors.initials: N
authors.lastname: Brusselaers
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D005260:Female; D006488:Hemostasis, Surgical / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013959:Thyroid Diseases / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy / Q000009:adverse effects* / Q000295:instrumentation; D016896:Treatment Outcome; D059708:Ultrasonic Surgical Procedures / Q000295:instrumentation*; D055815:Young Adult
keywords: Haemostasis; Harmonic focus; Non-inferiority; Thunderbeat; Thyroidectomy; Ultrasonic