Hemostasis in thyroid surgery: Harmonic scalpel versus other techniques—a meta‐analysis

Ecker, Thomas; Carvalho, André Lopes; Choe, Jun Ho; Walosek, Gudrun; Preuss, Klaus Juergen

doi:10.1016/j.otohns.2010.03.018

Cited by 139 publications

(132 citation statements)

References 29 publications

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“…10 The systematic review by Ecker et al shows difference in the mean VAS of 0.86. 13 In a study by Miccoli et al the VAS noted on 24 hours was less in ultrasonic group (3.9) as compared to 5.3 in the conventional group, similar findings were noted at 36 hours (2.27 vs 3.95).…”

Section: Discussionmentioning

confidence: 64%

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

Singhal

Baskota

Acharya

2018

Int J Otorhinolaryngol Head Neck Surg

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INTRODUCTIONRapid advancement in the medical technology has lead surgeons to use newer surgical instruments. Given the significant vascularity of the thyroid gland and the relatively small operative field, meticulous hemostasis has and will always be an important prerequisite for a successful outcome in thyroid surgery.1 Hemostasis in thyroid surgery is achieved by means of the conventional clamp-and-tie technique, diathermy, hemostatic clips, and recently, the UCCD.2-4 The ultrasonic technology was introduced in early 1990s and has four main functions of cutting the tissues, cavitation, co-aptation and coagulation of tissues. 5 Since the adoption of the UCCD into modern surgical practice, its utility for a wide variety of operations has been well documented.An ultrasonic based device when activated using ultrasound waves of a high-frequency (55 kHz) that can cut vessels of diameters up to 5 mm. 6 The active blade vibrates in longitudinal way against an inactive blade resulting in cutting and coagulation. The temperature ABSTRACT Background: The objective of this study was to compare the operative time and postoperative outcomes in thyroid surgeries using the ultrasonic cutting and coagulation device with conventional diathermy dissection. Methods: This study was a prospective, interventional, cohort study. The patients were randomized in two groups by lottery system. The patients operated with ultrasonic device were labeled as Group A: UCCD and by conventional diathermy as Group B: CDD. The operative time, postoperative drain volume, pain score on VAS and complications were assessed and compared in between the two techniques of surgery. Results: Total of 18 males and 58 females underwent thyroid surgery with age ranging from 17 to 75 years. The operative time in UCCD group was less than CDD group (93.29 min vs. 106.59 min; p=0.06). The cumulative mean amount of drain was found to be less in UCCD group, this difference was statistically significant (77.86 ml vs. 138.05 ml; p=0.00018). The drain was removed earlier in UCCD group, this comparison was also statistically significant (2.49 days in UCCD group vs. 3.02 days in CDD group; p=0.000009). The mean pain score was found to be statistically significant on all the postoperative days in UCCD group. Conclusions: The patients experienced less pain and complication while using UCCD as technique for surgery. Hence, ultrasonic device using both cutting and coagulating mode at the same time is efficient in hemostasis and lesser post-operative pain, and found to be advantageous.

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Section: Discussionmentioning

confidence: 64%

“…12 Ecker et al found the overall drain to be 20.03 ml less while operating with ultrasonic device. 13 Aziz et al found the postoperative drain on 1 st POD to be only 18.2 ml in comparison to 76 ml in conventional techniques. 10 The systematic review by Ecker et al shows difference in the mean VAS of 0.86.…”

Section: Discussionmentioning

confidence: 94%

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

Singhal

Baskota

Acharya

2018

Int J Otorhinolaryngol Head Neck Surg

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“…The single‐use device, HARMONIC FOCUS ® (Ethicon Endo‐Surgery, Johnson & Johnson, Cincinnati, Ohio, USA), has been evaluated in a number of clinical studies with discordant results. Although it is generally acknowledged that use of US reduces operating time7, 8, 9, 10, the impact on postoperative complications is unclear. Some studies have reported lower rates of complications, whereas others failed to demonstrate benefits over conventional haemostasis (CH)8, 9, 10, 11, 12, 13, 14.…”

Section: Introductionmentioning

confidence: 99%

Randomized clinical trial of ultrasonic scissorsversusconventional haemostasis to compare complications and economics after total thyroidectomy (FOThyr)

et al. 2017

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BackgroundThe benefits of single‐use ultrasonic scissors in thyroid surgery are still debated. Although this device has been shown to reduce operating time compared with conventional haemostasis, its cost‐effectiveness has never been demonstrated. The aim of this study was to evaluate the efficacy, cost‐effectiveness and safety of ultrasonic scissors for total thyroidectomy.MethodsThis was a prospective, randomized, multicentre trial conducted at 13 hospital sites. The primary endpoint was the percentage of patients with hypocalcaemia (serum calcium level below 2 mmol/l) on day 2. Secondary endpoints included postoperative complications and costs, with calculation of incremental cost differences and cost‐effectiveness ratios.ResultsIn total, 1329 patients who underwent total thyroidectomy were included in the analysis: 670 were randomized to treatment with ultrasonic scissors and 659 to conventional haemostasis. There was no difference between groups in the rate of complications, including hypocalcaemia on day 2 (19.7 per cent in ultrasonic scissors group versus 20.3 per cent in conventional haemostasis group; P = 0·743). Median operating times were significantly shorter with ultrasonic scissors (90 versus 100 min with conventional haemostasis; P < 0·001). Total mean(s.d.) direct costs at 6 months were €4311(1547) and €4011(1596) respectively (P < 0·001).ConclusionUltrasonic scissors were no more clinically effective than conventional haemostasis, but use of these devices was more costly. Registration number: NCT01551914 (http://www.clinicaltrials.gov).

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“…On the contrary, a potential drawback is, for some authors, the increased health care costs (10)(11)(12)(13)(14)(15)(16). In addition, EBD are essential for endoscopic procedures (16)(17)(18)(19)(20)(21)(22).…”

Section: Introductionmentioning

confidence: 99%

Safety of energy based devices for hemostasis in thyroid surgery

Dionigi¹,

Wu²,

Kim³

et al. 2016

Gland Surg.

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Energy based devices (EBD) have been developed, implemented and increasingly applied in thyroid surgery because they can provide a combined dissection and haemostatic effect. In particular, advantages of EBD have been described in terms of efficacious haemostasis, reduction of procedureassociated time, reduced incision length, less operative blood loss and transfusion need, decreased postoperative drain, pain and hospital stay. In addition, EBD are essential for endoscopic procedures. On the contrary, a potential drawback is the increased health care costs. This paper reviews relevant medical literature published on the safety of new devices for achieving hemostasis and dissection around the recurrent laryngeal nerve (RLN).

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Hemostasis in thyroid surgery: Harmonic scalpel versus other techniques—a meta‐analysis

Abstract: There is clear evidence that using the harmonic scalpel for hemostasis in thyroid surgery significantly reduces operating time and blood loss and that it is not associated with an increase in volume of drainage fluid, complication rate, or hospital stay.

Cited by 139 publications

References 29 publications

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

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

Randomized clinical trial of ultrasonic scissorsversusconventional haemostasis to compare complications and economics after total thyroidectomy (FOThyr)

Safety of energy based devices for hemostasis in thyroid surgery

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