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No Tie Technique Using Harmonic Scalpel for Thyroidectomy Versus Conventional Technique (A Prospective Study) | ||
| Kerbala Journal of Medicine | ||
| Article 1, Volume 9, Issue 1, 2016, Pages 2316-2323 PDF (0 K) | ||
| Author | ||
| Ali Azeez Ali | ||
| Abstract | ||
| background: The pioneers of thyroid surgery, Theodor Kocher and Theodor Billroth, developed an acceptable technique of standardized thyroid surgery in the nineteenth century. It includes three basic principles: identification and ligation of the feeding vessels, identification and preservation of the laryngeal nerves and identification and preservation of the parathyroid glands. The basic surgical instruments have not significantly changed, the main innovations are new methods of coagulation and vascular section. Aim: to compare the outcomes of total thyroidectomy and lobectomy, utilizing the conventional hemostatic technique (CH) and harmonic scalpel technique (HS). Patients and Methods: This study was carried at Al-Hussein medical city. In one group the tie and ligature technique was applied and the new harmonic scalpel technique was applied to the other group. The study variables are: operative time, post-operative drainage volume, recurrent laryngeal nerve (RLN) status and total serum calcium level in total thyroidectomy group. Student’s t test was used to compare quantitative variables, chi square test was to compare qualitative variables. Results: Seventy patients were included in this study, 40 patients had total thyroidectomy, and 30 patients underwent lobectomy. The mean operative time, in the total thyroidectomy group, was 83.4±13.2 minutes versus 60.3±5.3 minutes in the CH and HS respectively. And it was statistically significant. In the lobectomy group, the mean operative Time was 47.8±7.3 minute versus 38.8±6.8 minute in the CH and HS respectively. It was statistically significant. Post-operative drainage, in the total thyroidectomy group, was 128.6 ± 11.1 ml versus 98.1± 10.3 ml in the CH and HS group respectively. In the lobectomy group, it was 116.4±21.1 ml versus 62.8±8.6 ml in the CH and HS group respectively. And both are highly significant. Regarding RLN palsy, in the total thyroidectomy group, 2 patients out of 20 with CH versus 3 out of 20 with HS, sustained RLN palsy but statistically was non-significant. In the lobectomy group, 2 patients out of 14 with CH versus zero out of 16 patients with HS sustained RLN palsy also was non-significant. Regarding hypocalcaemia, in the total thyroidectomy group, 4 patients out of 20 with CH versus 3 patients out of 20 in the HS group developed post-operative hypocalcaemia and was statistically non-significant. Conclusion: Harmonic scalpel is a relatively safe, effective hemostatic tool in thyroid surgery. Complications are no more than that of conventional hemostatic technique. | ||
| Keywords | ||
| Harmonic scalpel; thyroidectomy; hypocalcaemia; RLN injury | ||
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