[Ultrasonic scalpel in thyroid surgery]

Area of Science:

• Surgical Technology
• Endocrinology
• Oncology

Background:

• Traditional thyroidectomy involves significant blood loss and operative time.
• Harmonic scalpel technology offers potential for improved hemostasis and dissection.
• Evaluating new surgical tools is crucial for optimizing patient outcomes in thyroid surgery.

Purpose of the Study:

• To prospectively evaluate the efficacy and safety of the harmonic scalpel versus traditional methods in open total thyroidectomy.
• To compare operative time, blood loss, and rates of transient and permanent nerve injury between the two techniques.

Main Methods:

• A prospective randomized study involving 142 patients with multinodular goiter undergoing total thyroidectomy.
• Patients were divided into two age- and gender-matched groups: harmonic scalpel (n=72) and traditional technique (n=70).
• Outcomes assessed included operative duration, blood loss, and rates of permanent/transient inferior laryngeal nerve palsy and hypoparathyroidism.

Main Results:

• The harmonic scalpel group demonstrated significantly reduced surgical duration (87.5% < 1 hour) and blood loss (P < 0.005).
• No significant difference in permanent inferior laryngeal nerve palsy or hypoparathyroidism rates between groups.
• Initial use of the harmonic scalpel showed a higher incidence of transient nerve injury (9.7% vs 1.4%), which decreased with experience.

Conclusions:

• The harmonic scalpel is a safe and effective adjunct for open total thyroidectomy, significantly improving efficiency.
• While transient nerve injury may be higher initially, it becomes comparable to traditional methods with increasing surgeon experience.
• The harmonic scalpel offers benefits in reducing operative time and blood loss without compromising long-term safety outcomes.