Ultrasonic harmonic scalpel in total thyroidectomies

Haemostasis is very important in thyroid surgery. In conventional surgery, electrocoagulation and suture ligation are used for haemostasis; newer techniques include vessel clips, ultrasonic instruments and lasers. The aim of this prospective study was to compare the usage of the ultrasonic harmonic scalpel (UHS) with conventional procedures, in total thyroidectomies, for operation time, blood loss, usage of drain, cost, length of hospitalisation and complications.

We examined 104 patients who underwent bilateral total thyroidectomy. They were divided randomly into two groups. Patients in Group I (n=54) underwent operations using conventional techniques (electrocautery and suture ligation) while patients in Group II (n=50) underwent operations using the UHS. Operation time, number of ligatures used, blood loss, intra-operative complications, weight of the specimen, necessity of drain, postoperative seroma, bleeding, infection, transient or permanent hypocalcaemia, permanent recurrent laryngeal nerve palsy and length of hospitalisation were recorded.

The operation time was significantly longer in Group I (conventional) (105+/-16 minutes; mean+/-standard deviation) than Group II (UHS) (77.9+/-12.5 minutes; P<0.001). The mean blood loss was less in patients who were operated on with the UHS (25.3+/-10.2 g) than in patients operated on with conventional methods (59.5+/-33.9 g; P<0.001). The mean number of ligatures used in the UHS group was 5.3, which was significantly fewer than the mean of 51.6 ligatures used in the conventional methods group (P<0.001). Drains were also used less in the UHS operations (12%-59%; P<0.001).

Use of the UHS in thyroid surgery results in decreased operation time, drain usage and amount of bleeding and does not increase postoperative complications. The UHS is an effective, reliable and less expensive technique for thyroid surgery.