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Related Experiment Video

Updated: Jun 17, 2026

Gasless Endoscopic Thyroidectomy via the Trans-Axillary Approach
05:10

Gasless Endoscopic Thyroidectomy via the Trans-Axillary Approach

Published on: September 15, 2023

Clipless and sutureless endoscopic thyroidectomy using only the harmonic scalpel.

Yoon Woo Koh1, Jae Hong Park, Jae Wook Kim

  • 1Department of Otolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Bucheon, Korea.

Surgical Endoscopy
|December 10, 2009
PubMed
Summary

The harmonic scalpel (HS) enables clipless and sutureless endoscopic thyroidectomy, reducing operative time and complications. This technique offers a safe and effective alternative to traditional methods for thyroid removal.

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Area of Science:

  • Endocrine Surgery
  • Minimally Invasive Surgery
  • Surgical Technology

Background:

  • Endoscopic thyroidectomy often requires supplementary instruments for hemostasis.
  • The harmonic scalpel (HS) has shown promise but typically needs additional tools.

Purpose of the Study:

  • To evaluate the safety and efficacy of using only the harmonic scalpel (HS) for hemostasis in clipless and sutureless endoscopic thyroidectomy.
  • To assess outcomes without supplementary instrumentation.

Main Methods:

  • 114 patients underwent endoscopic hemithyroidectomy (HT) or total thyroidectomy (TT) using a unilateral axillo-breast approach.
  • Hemostasis was achieved exclusively with the HS.
  • Perioperative complications, surgical, and pathological outcomes were analyzed.

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Last Updated: Jun 17, 2026

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Main Results:

  • Operating time was longer for total thyroidectomy (TT) than hemithyroidectomy (HT), but decreased significantly after the initial 50 cases.
  • Minor skin flap hematomas occurred in 3.3% of HT patients; no intraoperative hemorrhage or hematoma in the thyroidectomy field was observed.
  • Transient vocal cord palsy (4.3-4.5%) and temporary hypocalcemia (36.4% in TT) were noted, with no permanent nerve or parathyroid damage.

Conclusions:

  • The harmonic scalpel (HS) alone is a viable alternative for clipless and sutureless endoscopic thyroidectomy.
  • It offers reduced operating times and a low complication rate compared to conventional ligation or clipping.