[The harmonic scalpel and surgery of the thyroid gland]

The objective of the investigation was to test the effects and properties of a harmonious scalpel in operations of the thyroid gland. During a three-year period (1999-2001) for this indication at the Surgical Clinic of the Third Medical Faculty Charles University Prague on account of this indication 306 patients were operated, 133 with a harmonious scalpel and 173 by the classical technique. In the experimental part the authors made sure first that the necrotic changes in tissues surrounding the thyroid gland caused by the ultrasonic blade do not reach further than 1 mm from the line of resection. If this demand is respected, then the operations with a harmonious scalpel are safe, anatomically clear and physiological to a maximum extent. As compared with the classical approach, the authors did not observe a statistically significant difference as regards complications (i.e. early postoperative haemorrhage, paresis of the laryngeal recurrent nerve or permanent hypocalcaemia). After mastering of the surgical technique the time of operation is reduced as compared with the classical operation, the operation is almost bloodless and in the surgical wound no foreign material is left. The pathologist confirms that thyroid specimens obtained by the harmonious scalpel are more easily evaluated for assessment of the final diagnosis.

The authors outline the asset of a harmonious scalpel for thyroid surgery. They recommend its use in these operations, they consider however preliminary training of work with the harmonious scalpel an essential prerequisite for correctly performed work.