Evaluation of the ultrasonic dissector in thyroid surgery. A prospective randomised study

The use of ultrasonic dissectors in endoscopic surgery has proved to be of value, particularly for the prevention of bleeding and the reduction of electrical internal burns. This prospective randomised study was performed in order to evaluate the efficacy, security and cost of using the ultrasonic hook in thyroid surgery.

Thirty-four consecutive euthyroid patients with multinodular goitre for whom a total thyroidectomy was indicated, were randomly assigned either to group I, Ultracision or to group II, conventional hemostasis. Pre-, peri-, and postoperative biochemical, clinical, surgical and economical variables were compared between both groups.

The use of the ultrasonic hook resulted in a significant reduction in operating time, blood loss, and maybe in "transitory hypoparathyroidism"; postoperative analgesic consumption was also reduced in this group. Considering the cost, the ultrasonic hook was no more expensive than conventional hemostasis, as long as a minimum of 15 patients shared the initial unit cost of the device.

Even if the use of the ultrasonic dissector is not of major interest in terms of patient management or cost-saving in the context of total thyroidectomy, essential advantages reside in significant reductions of operating time, blood loss and organ injury, (particularly parathyroid). The reduced operating time undoubtedly represents a positive feature of the ultrasonic dissection technique.