Efficacy and safety of ultrasonically activated shears in thyroid surgery

Karvounaris, Dimitrios; Antonopoulos, V.; Psarras, Kyriakos; Sakadamis, Athanassios

doi:10.1002/hed.20445

Cited by 35 publications

(33 citation statements)

References 22 publications

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“…In experienced hands the rate of this complication is lower than 2% [10]. In line with previous studies, the use of a UHS did not increase the RLN palsy risk in our study [7,10,12]. The rate of transient hypocalceamia has been reported as %5-%15 and permanent hypocalcemia rates have been reported as %5 in total thyroidectomoies [12].…”

Section: Discussionsupporting

confidence: 90%

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Suturless Thyroidectomy

Karaca¹

2015

Ann Clin Anal Med

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ÖzetAmaç: Bu klinik çalışmanın amacı, Harmonik Scalpel (HS) ile yapılan sütürsüz tiroidektomileri konvansiyonel tiroidektomilerle evrensel parametreler açısın-dan karşılaştırmaktır. Gereç ve Yöntem: Bu prospektif randomize çalışma total tiroidektomi uygulanan 929 hasta üzerinde yapıldı. Hastalar randomize olarak 2 gruba ayrıldı. Grup I 461 hasta içeriyordu ve bu hastalara harmonic scalpel ile total tiroidektomi uygulandı. Grup II ise 468 hastadan oluşuyordu ve onlarada konvansiyonel tiroidektomi uygulandı. Bulgular: Operasyon süresi Grup I'e göre Grup II (49 ± 11min) (32 ± 8 dk) anlamlı olarak daha uzundu.Ortalama kan kaybı hastalarda her iki grupta da anlamlı değildi. Tiroid boyutunda istatistiksel olarak anlamlı bir fark yoktu. Geçici / kalıcı hipokalsemi oranları karşılaştırıldığında, iki grup benzerdi. Kalıcı RLN felci açısından istatistiksel olarak anlamlı fark yoktu Grup I'de beş hastada görüldü. Ameliyat sonrası kanama, enfeksiyon oranları, hastanede kalış süresi iki grup arasında farklı değildi. Tartışma: Sonuç olarak, tiroid cerrahisinde HS kullanımı, geleneksel yöntemlere göre ameliyat süresini kısaltmaktadır. Ameliyat sonrası komplikasyonlar arasında hiçbir fark yoktur. HS tiroid cerrahisinde etkili, uygun ve güvenilir bir yöntemdir. Anahtar KelimelerTiroid Cerrahisi; Harmonik Scalpel; Total Tiroidektomi Abstract Aim: Our purpose, Harmonic Scalpel (HS) and Conventional thyroidectomy in this clinical study was to compare in terms of universal parameters. Material and Method: This prospective randomized trial study was performed on these 929 consecutive patients given total thyroidectomy. Patients were randomly assigned to either the Focus group (in which the operation was performed entirely using the Harmonic Focus and no other hemostatic tool; 468 patients) or the classic group (in which the operation was performed using conventional clamp-and-tie technique and mono-polar electric scalpel; 461 patients). Results: The operation time was significantly longer in Group II (49±11min.) than Group I (32±8 min). The mean blood loss was not significantly in patients both groups. There was no statistically significant difference in specimen size. The two groups were similar when transient/permanent hypocalcaemia rates were compared. Permanent RLN palsy was seen in five patient in Group I. There was no statistically significant difference in drain usege. Postoperative bleeding, seroma, infection rates, hospitalisation time were not different between the two groups. Discussion: In conclusion, usage of the UHS in thyroid surgery decreases operation time when it is compared to conventional methods. On the other hand there is no difference in postoperative complications. The UHS is an effective, reliable and feasible technique in thyroid surgery.

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Section: Discussionsupporting

confidence: 90%

“…We calculated blood loss from the increase in weight of the blooded gauzes. Some authors have reported that the amount of bleeding did not differ between the two methods [7,12,13]. Also Defechereux et al5 reported a reduction in intra-operative bleeding.…”

Section: Discussionmentioning

confidence: 95%

Suturless Thyroidectomy

Karaca¹

2015

Ann Clin Anal Med

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“…Tiroidektomide Harmonic Scalpel son yıllarda yaygın olarak kullanılmakta olup etkinliği ile ilgili bir çok çalışma yapılmıştır (3,4,6,7,(9)(10)(11)(12)(13)(14). Harmonic Scalpel'ın kolay kullanımı ve manipülasyonu, diseksiyon, kesme ve koagülas-yon işlemini aynı anda yapabilmesi nedeniyle operasyon süresini kısalttığı bildirilmiş ve bununda cihazın en önemli avantajı olduğu vurgulanmıştır (6,7,(15)(16)(17) (10,18,19,22).…”

Section: Discussionunclassified

“…Kalıcı hipokalsemi ise paratiroid bezlerin çıkarılması ya da devaskularizasyonu sonucu oluşur. Tiroidektomi sonrası kalıcı hipokalsemi %0,3-3 ve geçici hipokalsemi %1,6-30 arasın-da bildirilmektedir (23)(24)(25)(26)28 Bazı yazarlar Harmonic Scalpel kullanımının drenaj miktarını değiştirmediğini belirtmişler (4,12,14). Bunun aksine yapılan birkaç çalışmada da tiroidektomide Harmonic Scalpel kullanımı postoperatif drenaj miktarını azalttığı belirtilmiştir (6,7,17,22).…”

Section: Discussionunclassified

Is Harmonic Scalpel Beneficial in Total Thyroidectomy?

Özcan¹,

Mescı²,

Çolak³

et al. 2015

Akd Med J

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ÖZAmaç: Tiroidektomide konvansiyonel tekniğin (KT) yıllardır güvenle uygulandığı bilinmektedir. Ancak teknolojinin ilerlemesi tiroid cerrahisinde de değişikliklere yol açmaktadır. Harmonic Scalpel (HS), bu yeni teknolojik cihazlardan biri olup elektrik enerjisini ultrasonik enerjiye çevirerek uç kısmındaki bıçakların yüksek frekanslı titreşmesiyle çalışır. Koagülasyon ve kesme işleminin aynı anda yapılmasına olanak sağlayarak diseksiyon kolaylığı sağlar. Bu çalışmanın amacı, total tiroidektomilerde HS kullanı-mının KT göre bir avantaj sağlayıp sağlamadığını araştırmaktır. Gereç ve ABSTRACTObjective: The aim of this study was to investigate whether the use of the Harmonic Scalpel (HS) provides advantages in total thyroidectomy compared with the conventional technique (CT). Material and Methods:A total of 200 consecutive patients who underwent total thyroidectomy at the Department of General Surgery of the Akdeniz University Faculty of Medicine between 02.11.2009 and 21.07.2010 were included in the study. The patients were randomly divided into two groups. A total of 100 patients who underwent thyroidectomy using HS comprised the fi rst group and the remaining 100 patients who underwent thyroidectomy with the use of CT comprised the second group. The demographic data of the patients, operation and total anesthesia times, incision length, drainage amount, complication rate, and the FNAB (fi ne needle aspiration biopsy) and histopathology results of both groups were compared.Results: Operation and anesthesia times were found to be 16 minutes shorter in thyroidectomies performed using HS compared to the CT group (p<0.001). Transient and permanent nerve injuries, hypocalcemia and postoperative hemorrhage rates were not different between the groups. Conclusion:The operation time was found to have shortened without changes in thyroidectomyrelated complication rates using HS in total thyroidectomy. Thus, we believe that the use of the Harmonic Scalpel is an effective and safe method in thyroid surgery.

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“…The use of ultrasonic's tweezers result in reduction of 15-20% for operatory time and has excellent cost/benefit ratio compared with the conventional technique 8 . In pulmonary lobectomies for example these costs are decreased in 30.8% when considering its use 5 . Studies of surgical time on hemorroidectomy showed that the operation time is significantly reduced with the use of high precision tweezers for cutting and coagulation in relation to the use of conventional knives.…”

Section: Introductionmentioning

confidence: 99%

Reprocessamento de pinças de alta resolução para corte e coagulação

Zilberstein

Silva

Valim

et al. 2013

ABCD, arq. bras. cir. dig.

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-Introduction:Several studies have demonstrated the clinical benefits of the use of high resolution instruments in surgery, with reduction in the operative time, easy handling and effectiveness in the incisions, as well as lower smoke generation and thermal tissue damage. Aim: To demonstrate the technical feasibility of reusing devices of high resolution for cutting and coagulation, theoretically recommended for single use. Method: Was evaluated the efficacy of cleaning, sterilization process and functional quality of the material. The process was applied in four tweezers brand Ligasure -Valleylab. Each was identified with ribbons of different colors autoclavable for tracking. Two were submitted directly to the cleaning after the first use and from the other two were collected samples of this cleaning for the first culture. All tweezers passed through the cleaning process prior to sterilization. Then were sterilized in hydrogen peroxide. After the sterilization process, was taken material from the devices and put it on saline solution for culture. After, the tweezers were tested by a surgeon to analyze its performance in a sample of beef. Randomly at each test the researcher contaminated tweezers with strains of Pseudomonas aeruginosa, Staphylococcus aureus and Candida albicans. This process was repeated four times. The material was sent to the laboratory and seeded in culture medium capable of microbiological identification. For quality control tests all biological, chemical and quality certification of products used in the process were attached. Results: The results of all cultures were negative, and functionality was preserved in the four reuses. Conclusion:As to the functionality, the tweezers may be used at least four times, the number of times tested in this experiment. Therefore, it can be used for five times, the first coming from the factory and four more after reprocessing. RESUMO -Introdução:Diversos estudos demonstraram as vantagens clínicas da utilização dos instrumentos de alta resolução em cirurgia, com a redução do tempo operatório, fácil manuseio e efetividade nas incisões, assim como menor geração de fumaça e danos térmicos teciduais. Objetivo: Demonstrar a viabilidade técnica de reutilização das pinças de alta resolução para corte e coagulação teoricamente recomendadas para uso único. Método: Foi avaliada a eficácia da limpeza, garantia do processo de esterilização e qualidade funcional do material. O processo foi aplicado em quatro pinças da marca Ligasure-Valleylab. Cada uma foi identificada com fitas autoclaváveis de cores diferentes para rastreamento. Duas foram submetidas diretamente à limpeza após a primeira utilização e nas outras duas foi coletado, antes desta limpeza, material para a primeira cultura. Todas as pinças passaram por processo de limpeza antes da esterilização. Em seguida foram esterilizadas em peróxido de hidrogênio. Após o processo de esterilização foi colhida, de cada pinça, cultura em meio de solução fisiológica. Após esta coleta todas as pinças foram testadas...

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Efficacy and safety of ultrasonically activated shears in thyroid surgery

Abstract: The use of UAS in thyroid surgery is a safe method for hemostasis, as well as for the division of blood vessels and thyroid tissue. It leads to the reduction of the total operative time without serious complications.

Cited by 35 publications

References 22 publications

Suturless Thyroidectomy

Suturless Thyroidectomy

Is Harmonic Scalpel Beneficial in Total Thyroidectomy?

Reprocessamento de pinças de alta resolução para corte e coagulação

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