Use of the Harmonic Scalpel in Thyroid Surgery - Review of the Literature
Use of the Harmonic Scalpel in Thyroid Surgery - Review of the Literature
European Endocrine Disease 2006 Issue 2
Published: October 2008
Published: October 2008
This review aims to evaluate the impact of the use of the Harmonic Scalpel in reducing operating time in open thyroid surgery compared with conventional surgical techniques (suture ligatures, clips and electrocoagulation). As a secondary goal, the review examines the evidence of additional advantages of the harmonic devices compared with conventional techniques in terms of intra-operative blood loss, amount of post-operative fluid drainage, either reducing or eliminating the use of clips and sutures ligatures, minimising patient pain intensity at the surgical site and preventing complications such as incidence of recurrent laryngeal nerve palsy and hypoparathyroidism.
The primary outcome measure is operating time, measured in minutes, from the first skin incision to the last skin suture. The intra-operative blood loss, amount of post-operative fluid drainage in millimetres, number of clips and suture ligatures and subjective pain intensity at the surgical site, as well as postoperative complications such as incidence of recurrent laryngeal nerve palsy and hypoparathyroidism, are considered secondary outcomes.
The authors searched MEDLINE, EMBASE and the Cochrane Controlled Trials Register using the terms harmonic, Harmonic Scalpel, UltraCision, ultrasonic activated devices, thyroid surgery, thyroidectomy, hemithyroidectomy, lobectomy, electrocoagulation, suture ligatures and clips. The Science Citation Index was searched to identify trials that had cited the studies. The authors searched citation lists of relevant studies for other relevant trials.
Randomised clinical trials, evidence level 1b (according to the US Agency for Health Care Policy and Research (AHCPR)) were considered.
All relevant randomised clinical trials were considered and the full reports obtained. Selection bias, performance bias, measurement bias and attrition bias were looked for, described, evaluated and tabulated. Methods of measurement used in trials are described and their relevance, validity and reproducibility discussed. Data were extracted independently for each study; differences were analysed. Outcome measurement data were summarised and presented as primary and secondary outcome results.
Five on 12 randomised controlled trials, published between 1998 and 2006, which seemed to us to fulfil the requested criteria, were reviewed. In all the included clinical trials, adult patients with malignancies and benign diseases of the thyroid gland who underwent open thyroid surgery using harmonic or conventional techniques (suture ligatures, clips and electrocoagulation) were randomly assigned. In two trials, only patients with benign diseases were included. In three clinical trials, patients with both malignancies and benign diseases were included. All patients in the five included trials were similar in mean age, race and gender.
