The Use of Harmonic Focus and Thunderbeat Open Fine Jaw in Thyroid Surgery: Experience of a High-Volume Center

Abstract

Background: In thyroid surgery, achieving accurate haemostasis is fundamental in order to avoid the occurrence of complications. Energy-based devices are currently extensively utilized in this field of surgery. This study aims to compare Harmonic Focus and Thunderbeat Open Fine Jaw with regard to surgical outcomes and complications. Methods: Patients submitted to total thyroidectomy in our center, between January 2017 and June 2020, were retrospectively analysed. Based on the energy-based device utilized, two groups were identified: Group A (Harmonic Focus) and Group B (Thunderbeat Open Fine Jaw). Results: A total of 527 patients were included: 409 in Group A and 118 in Group B. About surgical outcomes, the mean operative time was significantly shorter in Group B than in Group A (p < 0.001), while as regards complications, the occurrence of transient recurrent laryngeal nerve injury was significantly greater in Group B than in Group A (p = 0.019). Conclusions. Both Harmonic Focus and Thunderbeat Open Fine Jaw have proven to be effective devices. Operative times were significantly shorter in thyroidectomies performed with Thunderbeat Open Fine Jaw; however, the occurrence of transient recurrent laryngeal nerve injury was significantly greater in patients operated on with this device.

Clinical Usefulness of the Valsalva Manoeuvre to Improve Hemostasis during Thyroidectomy

“…However, drains usage may be omitted as unnecessary in uncomplicated cases because the drained volume is frequently very low, or because haemostasis was adequate during surgery [ 14 , 15 ]. In light of improvements in haemostatic techniques and increasing surgical skills, the value of drainage in thyroid surgery may again be questioned; using energy devices and advanced hemostatic agents could reduce drain output, making the use of drainage tubes less useful [ 16 , 17 , 18 , 19 , 20 ]. However, we believe that life-threatening complications (such as postoperative bleeding, haematoma, compression of the airways, or suffocation) can be more promptly signaled by the presence of drains, and can guarantee the surgeon a timelier diagnosis and a less rapid onset of symptoms associated with haematoma for patients [ 21 , 22 ].…”

Recent Advances in the Surgical Management of Thyroid Cancer

“…Since the early 2000s, new hemostasis energy devices (Harmonic, Ligasure, Thunderbeat devices, etc.) have been developed [56][57][58][59]. These devices represent a safe and efficient alternative to the traditional clamp-and-tie hand technique in thyroid surgery, yielding a reduction in operating time while not increasing RLN injury rates [56][57][58][59].…”

“…have been developed [56][57][58][59]. These devices represent a safe and efficient alternative to the traditional clamp-and-tie hand technique in thyroid surgery, yielding a reduction in operating time while not increasing RLN injury rates [56][57][58][59]. The sealing of vessels up to 7 mm in diameter can be securely achieved with these devices, which is largely sufficient for thyroid surgery [59].…”

“…Although thermal spread is minimal, these devices should be used with caution near the RLN, particularly at its laryngeal penetration. A reduction in the risk of postoperative hematoma following thyroid surgery has been shown with these devices compared with conventional hemostatic techniques [56,57]. There is no clear evidence that one device is superior to another for thyroid surgery [57][58][59].…”

“…A reduction in the risk of postoperative hematoma following thyroid surgery has been shown with these devices compared with conventional hemostatic techniques [56,57]. There is no clear evidence that one device is superior to another for thyroid surgery [57][58][59]. Each surgeon may have his own preferences according to his experience and skills, but surgical morbidity in thyroid surgery remains highly associated with surgical volumes [4,6,55].…”