Comparison of surgical outcomes of Ultrasonic technique (Harmonic Focus™) with Conventional technique in open hemithyroidectomy

Abstract

Background: The option for dissection and haemostasis during thyroid surgery include either the modern ultrasonic technology (Harmonic Focus™) or the conventional technique using knot and ties, monopolar or bipolar electrocautery. Comparison between the surgical outcomes of open hemithyroidectomy using these two modalities was done.Objective: To compare the surgical outcomes of ultrasonic technique using Harmonic Focus™ (HS) with Conventional technique (CT) in open hemithyoidectomy.Method: Twenty consecutive patients undergoing open hemithyroidectomy for benign solitary thyroid nodule of ≤ 3 cm were randomly assigned into two groups; group HS (n=10) and group CT (n=10). Analysis of surgical outcomes performed by these two techniques, particularly: operative time, intra-operative blood loss, post operative pain, incision size, complications and hospital stay were done.Results: The age, sex and pathologies were comparable in both the groups. For the group HS, mean operative time was (mean ± SD=55 ± 5 min) 15 minutes shorter than group CT (mean ± SD= 70 ± 10 min) (P<0.01). Mean operative blood loss was (mean ± SD=20 ±10 ml) 16 ml less in group HS than CT (mean ± SD= 36 ±12 ml) (P<0.01). The group HS experienced less post operative pain (mean ± SD=4 ± 0.94 VAS) than CT (mean ± SD= 7 ± 0.81 VAS) (P<0.001). The incision size at the time of skin closure was 1.6 cm shorter in group HS ((mean ± SD= 3.95 ±0.61 vs. 5.5 ± 0.78cm) (P<0.01). Hospital stay (mean ± SD= 2.30 ± 0.48 vs. 4.20 ±0.42 days) was statistically significant (P<0.01) in group HS than CT. There were no major complications.Conclusion: In patients undergoing open hemithyroidectomy, HS is a faster, better cosmetic, safe and less morbid tool than CT. Its use reduces operative time, blood loss, post operative pain, scar size, along with hospital stay.DOI: http://dx.doi.org/10.3126/jkmc.v2i4.11774 Journal of Kathmandu Medical CollegeVol. 2, No. 4, Issue 6, Oct.-Dec., 2013Page: 175-180

Ultrasonic cutting and coagulation device versus conventional diathermy dissection in thyroid surgery: prospective randomized trial

“…Till date there is only one study in Nepal that compares the efficacy of ultrasonic based device with the conventional techniques. 8 In addition in this study the patients undergoing sub-total, near and total thyroidectomy were also compared. …”

A comparative study between harmonic scalpel hemostasis and conventional hemostasis in total thyroidectomy

“…12 Regmi et al showed that thyroidectomy by ultrasonic technique resulted in less intraoperative blood loss by 16 ml than in conventional thyroidectomy. 26 Rienzo et al showed in their series that intraoperative blood loss was comparable when they used a harmonic scalpel and Liga Sure vessel sealing device and significantly less than in the conventional clamping and knot-tying technique. 27 And all authors reported that the difference was statistically significant.…”

Appropriateness of perioperative antibiotics in thyroid surgery

“…20 In contrary to the recommendations, many centers in Nepal and India, antibiotics are being prescribed for various duration following thyroidectomy. [4][5][6] In an international survey among endocrine surgeons, the patterns of antibiotic use varied widely among European, American and Asian surgeons. Most of the Asian surgeons (58.3%) almost always prescribed antibiotic prophylaxis in contrary to European surgeons whereby only 8.8% do so routinely.…”

“…4 In most of the centers in Nepal, perioperative antibiotics are still administered for varying duration. 5,6 At Patan Hospital, Nepal, study regarding use of antibiotic prophylaxis has not been done in thyroid surgery, but, a study on low risk laparoscopic cholecystectomy, regarded as clean surgery, routine use of antibiotic prophylaxis did not show added advantage in preventing SSI. 7 There is a dearth of literature regarding antibiotic prophylaxis in our set up.…”