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

Aires, Felipe Toyama; Matos, Leandro Luongo de; Dedivitis, Rogério Aparecido; Cernea, Cláudio Roberto

doi:10.1590/1806-9282.64.07.649

Cited by 8 publications

(10 citation statements)

References 46 publications

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“…Harmonic devices were associated with reductions in operating time across all nine systematic reviews ranging from -0.10 min to -29.29 min compared to conventional methods [ 15 , 17 , 20 , 23 , 24 , 27 , 35 , 37 , 38 ]. A statistically significant reduction in operating time was reported for cholecystectomy [ 27 ], flap harvesting [ 24 ], gastrectomy [ 20 ], hemorrhoidectomy [ 17 ], neck dissection [ 38 ], and thyroidectomy [ 35 ]. Both systematic reviews showed lower operating time with Harmonic than ABP device comparators, but differences were not significant (Table 2 ) [ 15 , 16 ].…”

Section: Resultsmentioning

confidence: 99%

“…3 B, Supplementary Table 7 ). Harmonic devices were associated with a reduction in LOS in all seven systematic reviews ranging from -0.01 days to -1.35 days [ 15 – 17 , 20 , 23 , 27 , 38 ], with results being statistically significant for cholecystectomy [ 27 ], mastectomy [ 23 ], and thyroidectomy [ 35 ]. Both systematic reviews for colectomy and thyroidectomy that compared Harmonic to ABP devices showed no significant differences for LOS (Table 2 ) [ 15 , 16 ].…”

Section: Resultsmentioning

confidence: 99%

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An umbrella review of the surgical performance of Harmonic ultrasonic devices and impact on patient outcomes

et al. 2023

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Background For thirty years, the Harmonic scalpel has been used for precise dissection, sealing and transection. There are numerous meta-analyses on individual surgical procedures with Harmonic, but no overarching review covering all the areas. This umbrella review seeks to summarize the clinical results from the use of Harmonic across surgical fields and broadly quantify its effects on patient outcomes. Methods MEDLINE, EMBASE, and Cochrane Databases were searched for meta-analyses (MAs) of randomized controlled trials (RCTs) comparing Harmonic devices to conventional techniques or advanced bipolar (ABP) devices. For each procedure type, the most comprehensive MAs were evaluated. RCTs not already analysed in a MA were also included. Operating time, length of stay, intraoperative blood loss, drainage volume, pain, and overall complications were evaluated, and the methodological quality and certainty of evidence were assessed. Results Twenty-four systematic literature reviews were identified on colectomy, hemorrhoidectomy, gastrectomy, mastectomy, flap harvesting, cholecystectomy, thyroidectomy, tonsillectomy, and neck dissection. There were also 83 RCTs included. In every MA evaluated, Harmonic devices were associated with either statistically significant or numerical improvements in every outcome compared with conventional techniques; most MAs reported a reduction in operating time of ≥ 25 min. Harmonic versus ABP device MAs in colectomy and thyroidectomy showed no significant differences in outcomes. Conclusion Across surgical procedures, Harmonic devices demonstrated improved patient outcomes for operating time, length of stay, intraoperative bleeding, drainage volume, pain, and overall complications compared to conventional techniques. Additional studies are required to assess differences between Harmonic and ABP devices.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

An umbrella review of the surgical performance of Harmonic ultrasonic devices and impact on patient outcomes

et al. 2023

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“…Hematomas that form in enclosed spaces can expose the pedicle to constant pressure, resulting in flap morbidities. It has been accepted that harmonic scalpels effectively enable hemostasis, resulting in less intraoperative bleeding and postoperative hematoma formation (Aires et al, 2018;Fritz et al, 2016;Zhang et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

Harmonic scalpels compared with electrocautery in reconstructive flap harvesting: A meta‐analysis

2021

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Background: Numerous studies have compared electrical devices used for flap surgery, but the results are inconsistent. This research was performed to evaluate the efficacy of two different types of electric devices: electrocautery and ultrasonic shears. Methods:The PubMed, Embase, and Scopus databases were searched systematically. A total of 505 cases were included in this study, including 209 electrocautery and 296 harmonic scalpel cases. The following information was retrieved from the included studies: the first author of the article, publication year, flap type, flap harvest time, drain volume, bleeding volume and postoperative complications. Hematoma, infection, flap necrosis and wound dehiscence were considered postoperative complications. The Q statistic for heterogeneity and the I 2 index were calculated. If I 2 < 50%, we used a fixed-effects model; if I 2 > 50%, we employed a random-effects model in our meta-analysis.Results: A total of eight studies which met the inclusion criteria were included and reviewed systematically for a meta-analysis. The harmonic scalpel yielded a statistically significantly more favorable flap harvest time and drain volume than did electrocautery. The Harmonic scalpel led to a shorter flap harvest time by 26.29 min (95% CI = À39.38 to À13.2; p < .00001) and smaller drain volume by 58.76 ml (95% CI = À105.27 to À12.25; p = .01) on average. However, there were no significant differences in the bleeding volume or incidence rates of infection, flap necrosis and wound dehiscence. Conclusion:The Harmonic scalpel method yields better outcomes in terms of the flap harvest time and drain volume than does the conventional electrocautery method.Therefore, the Harmonic scalpel is a better option for cauterization and dissection in flap surgery.

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“…The literature also has demonstrated a trend toward lowered rates of RLN injury 9 . A meta-analysis reported significant advantages in operative time and intraoperative blood loss, but not postoperative hematomas 15 . LigaSure system use was associated with shorter operative times 16–19 and hospital stays 17 .…”

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confidence: 99%

“…Several studies have evaluated the advantages and disadvantages of these devices compared with conventional techniques in thyroid surgeries 3,5–21 . Use of harmonic technology has been shown to be associated with numerous advantages over conventional hemostatic techniques, including lower cost, 3 shorter operative times, 5–14,22 less intraoperative blood loss, 14 shorter hospital stay, 8 transient hypocalcemia, 7,9,11 and less postoperative pain 7,8,11 .…”

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confidence: 99%

Vessel Sealant Devices in Thyroidectomies: An ACS-NSQIP Study

Németh¹,

Kong²,

Hwang³

et al. 2022

Southern Medical Journal

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Objectives: Thyroidectomies involve meticulous dissection of a highly vascularized organ and complications may develop, such as hematoma, hypocalcemia, and even hypoparathyroidism. Because some of these complications may be fatal, we sought to identify the differences in postthyroidectomy outcomes when the use of a vessel sealant device (VSD) such, as LigaSure or Harmonic scalpel, is compared with more traditional techniques, such as ligatures and clips. Methods:Using the 2016 American College of Surgeons National Surgical Quality Improvement Program Targeted Thyroidectomy database, we compared patients who underwent a thyroidectomy using a VSD with patients without a VSD for differences in postoperative complications.Results: A total of 5146 cases were identified and 3452 of those cases used a VSD, whose use was associated with significantly lower rates of hematoma, deep vein thrombosis, and hypocalcemia before discharge, as well as a shorter length of stay and longer operation time. Multivariate logistic regression showed that VSD was associated with 32.27% and 39.15% lower odds of hypocalcemia and hematoma, respectively. VSDs also were used more frequently in cases that had multinodular, severe, or substernal goiter or Graves disease as the primary indication for surgery and in patients with a higher body mass index. There was no significant difference in the incidence of recurrent laryngeal nerve injury between the two groups.Conclusions: Analysis of the American College of Surgeons National Surgical Quality Improvement Program data indicates that VSDs are associated with a lower risk of complications, such as hypocalcemia, hematoma, and deep vein thrombosis, suggesting that VSDs may be a more effective method of hemostasis than traditional techniques.

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

Cited by 8 publications

References 46 publications

An umbrella review of the surgical performance of Harmonic ultrasonic devices and impact on patient outcomes

An umbrella review of the surgical performance of Harmonic ultrasonic devices and impact on patient outcomes

Harmonic scalpels compared with electrocautery in reconstructive flap harvesting: A meta‐analysis

Vessel Sealant Devices in Thyroidectomies: An ACS-NSQIP Study

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