Total thyroidectomy with ultrasonic scalpel: A multicenter, randomized controlled trial

Kowalski, Luiz Paulo; Sanábria, Álvaro; Vartanian, José Guilherme; Lima, Roberto A.; Mendonca, Ullianov Bezerra Toscano de; Santos, Carlos Roberto dos; Júnior, Domingos Boldrini; Mello, Luiz Guilherme Marchesi; Pinto, Fernando Paiva; Lehn, Carlos Neutzling; Correa, Luiz Artur Costa; Dedivitis, Rogério Aparecido; Guimarães, André Vicente; Pedruzzi, P.A.G.; Ramos, Gyl Henrique Albrecht; Gonçalves, Antônio José; Suehara, Alexandre Babá; Kanda, Jossi Ledo; Capuzzo, Renato de Castro; Oliveira, José Carlos de; Curado, María Paula; Filho, José Francisco de Góis; Fukuyama, Érica Erina; Júnior, Ivo Marquis Beserra; Neto, Paulo Bentes de Carvalho; Carvalho, André Lopes

doi:10.1002/hed.21815

Cited by 17 publications

(13 citation statements)

References 43 publications

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“…The sample sizes of the included studies ranged from 20 to 261 patients. Six studies reported cost data for thyroidectomy, 18 , 19 , 22 , 23 , 25 , 26 two studies reported data for Nissen fundoplication, 24 , 27 two studies reported data for colectomy, 20 , 28 and three studies reported data for other surgical procedures (ie, cholecystectomy, 29 pancreaticoduodenectomy, 30 and gastrectomy 21 ). In all studies, Harmonic devices were compared to conventional techniques.…”

Section: Resultsmentioning

confidence: 99%

“…The UltraCision Harmonic Scalpel or Shears were used in seven studies, 18 – 20 , 24 , 27 – 29 the Harmonic Focus was used in three studies, 21 , 22 , 26 the Harmonic CS-14C 25 and the Harmonic Wave 30 were used in one study each, and one study did not specify the type of Harmonic device that was used. 23 …”

Section: Resultsmentioning

confidence: 99%

“…Different comparators were used for the Harmonic devices in these studies; eight studies used monopolar or bipolar electrocautery with one or more of sutures, clips, clamp and tie, or ligation, 19 – 22 , 26 , 28 – 30 while ligatures and cauterization, 18 cut and ligature, 23 right-angled multifire clip applier, 24 knot-tying, 25 and Ligaclips 27 were used by one study each. Three studies had three arms (ie, Harmonic device, conventional techniques, LigaSure vessel sealing system [n=2], or electrothermal bipolar vessel sealers [n=1]).…”

Section: Resultsmentioning

confidence: 99%

“… 20 , 26 , 28 Most studies (n=9) originated in Europe (eg, Italy, Spain, France, Sweden). Other regions included Japan (n=1), 21 Brazil (n=1), 23 and USA (n=2). 24 , 27…”

Section: Resultsmentioning

confidence: 99%

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Procedure costs associated with the use of Harmonic devices compared to conventional techniques in various surgeries: a systematic review and meta-analysis

Cheng¹,

Clymer²,

Qadeer³

et al. 2018

CEOR

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BackgroundAs compared to conventional techniques, recent meta-analyses have reported cost savings with Harmonic devices; however, only in thyroidectomy. Thus, the aim of this study was to evaluate the costs associated with Harmonic devices versus conventional techniques across a range of surgical procedures.MethodsA systematic search of MEDLINE, EMBASE, and Cochrane Library was conducted from inception to October 01, 2016 without language restrictions to identify randomized controlled trials comparing Harmonic devices to conventional techniques and reporting procedure costs (operating time plus operating equipment/consumables/device costs). Costs were pooled using the ratio of geometric means, and a random effects model was applied. Sensitivity analyses varying statistical methods, number of included studies, and cost outcomes were completed to test the robustness of the results.ResultsThirteen studies met the inclusion criteria. A total of 561 and 540 participants had procedures performed with Harmonic devices and conventional methods, respectively, with procedures including gastrectomy, thyroidectomy, colectomy, cholecystectomy, Nissen fundoplication, and pancreaticoduodenectomy. As compared to conventional methods, Harmonic devices reduced total procedure costs by 8.7% (p=0.029), resulting in an absolute reduction of US$227.77 from mean conventional technique costs, derived primarily from a reduction in operating time costs. When operating time costs, excluding operating equipment/consumables/device costs, were analyzed, costs were reduced by $544 per procedure with the use of Harmonic devices. The results from all sensitivity analyses demonstrated cost reductions with Harmonic devices.ConclusionThis systematic review and meta-analysis showed that despite a higher device cost, Harmonic devices provide a statistically significant reduction in procedure costs, derived primarily from a reduction in operating time costs, across surgical procedures. In addition to functionality benefits, Harmonic devices may represent a potentially cost saving method to reduce overall hospital resource use. Future research should focus on potential costs and benefits from use of Harmonic devices in procedures not covered here.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“… 20 , 26 , 28 Most studies (n=9) originated in Europe (eg, Italy, Spain, France, Sweden). Other regions included Japan (n=1), 21 Brazil (n=1), 23 and USA (n=2). 24 , 27…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Procedure costs associated with the use of Harmonic devices compared to conventional techniques in various surgeries: a systematic review and meta-analysis

Cheng¹,

Clymer²,

Qadeer³

et al. 2018

CEOR

View full text Add to dashboard Cite

show abstract

“…All primary studies were described as a randomized clinical trial. Of the 31 studies, only ten adequately described the randomization and allocation of patients 14,16,22,24,28,30,33,34,42,43 . In 17 studies the method of randomization was not describ ed 15,[17][18][19][20]25,26,27,29,31,32,[35][36][37][38][39]41 and in another four it was considered inappropriate 13,21,23,40 .…”

Section: Assessment Of Methodological Risk Of Primary Studiesmentioning

confidence: 99%

Effectiveness of harmonic scalpel in patients submitted to total thyroidectomy: systematic review with meta-analysis

Aires

Matos

Dedivitis

et al. 2018

Rev. Assoc. Med. Bras.

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OBJECTIVE: The objective of this study was to evaluate the efficacy and safety of the harmonic scalpel compared to the conventional technique in patients submitted to total thyroidectomy. METHOD: This is a systematic review with inclusion of randomized controlled trials (RCTs) that compared both techniques. An electronic search was carried out in the Medline and Lilacs databases until June 2017. The outcomes analysed were operation time, intraoperative bleeding, surgical morbidity, and costs. RESULTS: Data from 31 primary studies were included. The use of the harmonic scalpel correlates to a shorter operation time (p <0.001) and a lower volume of intraoperative bleeding (p <0.001). There were no differences in the risk of transient (p = 0.53) and permanent (p = 0.70) hypocalcaemia, transient (p = 0.61) and permanent (p = 0.50) dysfunctions of the inferior laryngeal nerve and hematoma (p = 0.14). CONCLUSION: Total thyroidectomy using a harmonic scalpel is effective and safe compared to the conventional technique.

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Hemostatic Devices

Vanella

Crocco

Traini

et al. 2016

Minimally Invasive Therapies for Endocrine Neck Diseases

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Total thyroidectomy with ultrasonic scalpel: A multicenter, randomized controlled trial

Abstract: The use of an ultrasonic scalpel was as safe as that of the conventional technique and had the advantage of a shorter operative time and lower postoperative drainage. Costs were not different between groups.

Cited by 17 publications

References 43 publications

Procedure costs associated with the use of Harmonic devices compared to conventional techniques in various surgeries: a systematic review and meta-analysis

Procedure costs associated with the use of Harmonic devices compared to conventional techniques in various surgeries: a systematic review and meta-analysis

Effectiveness of harmonic scalpel in patients submitted to total thyroidectomy: systematic review with meta-analysis

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