Korean J Endocr Surg.  2009 Dec;9(4):206-210. 10.16956/kjes.2009.9.4.206.

A Comparison of the Usefulness and Safety of the Harmonicâ„¢ Scalpel, Ligasureâ„¢ System, and Classic Clamp-and-Tie Technique for Hemostasis during Thyroid Surgery

• Yu JM
• Han JE
• Kim YH
• Kim JR

• KMID: 2375734
• DOI: http://doi.org/10.16956/kjes.2009.9.4.206

Abstract

PURPOSE
The aim of this study was to compare the outcome of total thyroidectomy performed with the Ligasureâ„¢ system, Harmonicâ„¢ scalpel, and the conventional clampand-tie technique.
METHODS
Between November 2006 and July 2009, the data were retrospectively collected from 600 consecutive total thyroidectomies by one surgeon. All cases were divided into 3 groups based on the method of hemostasis: classic group patients (n=200) underwent total thyroidectomy with the conventional clamp-and-tie technique Ligasure group patients (n=200) underwent total thyroidectomy with the Ligasureâ„¢ system (electrothermal bipolar vessel sealing system) and the Harmonic group patients (n=200) underwent total thyroidectomy with a Harmonicâ„¢ scalpel (ultrasonic cutting and coagulating surgical device). We compared the clinical outcomes with respect to the operative time, amount and duration of drainage, hospital stay, and post-operative complications.
RESULTS
The three groups were similar with respect to clinical and demographic characteristics, with the exception of invasiveness. The mean operative time of the Harmonic group was significantly shorter than the other 2 groups (P<0.001) specifically, 75 min in the Harmonic group, 87 min in the Ligasure group, and 120 min in the classic group. The amount of drainage in the Harmonic group was greater than the other groups (P<0.001). Similarly, the duration of drainage and hospital stay of the Harmonic group were longer than the other groups. There was no significant difference in the incidence of complications between the three groups.
CONCLUSION
Hemostasis during thyroidectomy by the Harmonicâ„¢ scalpel or Ligasureâ„¢ system was safe and timesaving. Therefore, the Harmonicâ„¢ scalpel and Ligasureâ„¢ system will be available for thyroid surgery as alternative techniques for the clamp-and-tie technique.

Keyword

Thyroidectomy; Harmonic; Ligasure

MeSH Terms

Drainage
Hemostasis*
Humans
Incidence
Length of Stay
Methods
Operative Time
Retrospective Studies
Thyroid Gland*
Thyroidectomy

Reference

References

1). Siperstein AE, Berber E, Morkoyun E. The use of the harmonic scalpel vs conventional knot tying for vessel ligation in thyroid surgery. Arch Surg. 2002; 137:137–42.

2). Manouras A, Lagoudianakis EE, Antonakis PT, Filippakis GM, Markogiannakis H, Kekis PB. Electrothermal bipolar vessel sealing system is a safe and time-saving alternative to classic suture ligation in total thyroidectomy. Head Neck. 2005; 27:959–62.

3). Gelmini R, Romano F, Quaranta N, Caprotti R, Tazzioli G, Colombo G, et al. Sutureless and stapleless laparoscopic splenectomy using radiofrequency: Ligasure device. Surg Endosc. 2006; 20:991–4.

4). Defechereux T, Rinken F, Maweja S, Hamoir E, Meurisse M. Evaluation of the ultrasonic dissector in thyroid surgery. A prospective randomised study. Acta Chir Belg. 2003; 103:274–7.

5). Manouras A, Lagoudianakis EE, Antonakis PT, Filippakis GM, Markogiannakis H, Kekis PB. Electrothermal bipolar vessel sealing system is a safe and time-saving alternative to classic suture ligation in total thyroidectomy. Head Neck. 2005; 27:959–62.

6). Miccoli P, Berti P, Dionigi GL, D'Agostino J, Orlandini C, Donatini G. Randomized controlled trial of harmonic scalpel use during thyroidectomy. Arch Otolaryngol Head Neck Surg. 2006; 132:1069–73.

7). Kiriakopoulos A, Tsakayannis D, Linos D. Use of a diathermy system in thyroid surgery. Arch Surg. 2004; 139:997–1000.

8). Lee CM, Kang DY, Kim JR. A comparison of conventional thyroidectomy and LVSS thyroidectomy: The feasibility of the LVSS in the thyroid operation. Korean J Surg Soc. 2009; 76:149–53.

9). Ohtsuka T, Wolf RK, Wurnig P, Park SE. Thoracoscopic limited pericardial resection with an ultrasonic scalpel. Ann Thorac Surg. 1998; 65:855–6.

10). Shigemura N, Akashi A, Nakagiri T. New operative method for a giant bulla: sutureless and stapleless thoracoscopic surgery using the Ligasure system. Eur J Cardiothorac Surg. 2002; 22:646–8.

11). Daskalopoulos G, Karyotis I, Heretis I, Delakas D. Electrothermal bipolar coagulation for radical prostatectomies and cystectomies: a preliminary case-controlled study. Int Urol Nephrol. 2004; 36:181–5.

12). Tamussino K, Afschar P, Reuss J, Perschler M, Ralph G, Winter R. Electrosurgical bipolar vessel sealing for radical abdominal hysterectomy. Gynecol Oncol. 2005; 96:320–2.

13). Deo SV, Shukla NK. Modified radical mastectomy using harmonic scalpel. J Surg Oncol. 2000; 74:204–7.

14). Lee WJ, Chen TC, Lai IR, Wang W, Huang MT. Randomized clinical trial of Ligasure versus conventional surgery for extended gastric cancer resection. Br J Surg. 2003; 90:1493–6.

15). Cordon C, Fajardo R, Ramirez J, Herrera MF. A randomized, prospective, parallel group study comparing the Harmonic Scalpel to electrocautery in thyroidectomy. Surgery. 2005; 137:337–41.

16). Dror A, Salim M, Yoseph R. Sutureless thyroidectomy using electrothermal system: a new technique. J Laryngol Otol. 2003; 117:198–201.

17). Lachanas VA, Prokopakis EP, Mpenakis AA, Karatzanis AD, Velegrakis GA. The use of Ligasure Vessel Sealing System in thyroid surgery. Otolaryngol Head Neck Surg. 2005; 132:487–9.

18). Voutilainen PE, Haglund CH. Ultrasonically activated shears in thyroidectomies: a randomized trial. Ann Surg. 2000; 231:322–8.

19). Shemen L. Thyroidectomy using the harmonic scalpel: analysis of 105 consecutive cases. Otolaryngol Head Neck Surg. 2002; 127:284–8.

20). Ortega J, Sala C, Flor B, Lledo S. Efficacy and cost-effectiveness of the Ultracision harmonic scalpel in thyroid surgery: an analysis of 200 cases in a randomized trial. J Laparoendosc Adv Surg Tech A. 2004; 14:9–12.

21). Rosato L, Avenia N, Bernante P, De Palma M, Gulino G, Nasi PG, et al. Complications of thyroid surgery: analysis of a multicentric study on 14,934 patients operated on in Italy over 5 years. World J Surg. 2004; 28:271–6.

22). Anonymous (2001) Ultracision Harmonic Scalpel user's manual. Ehticon Endosurgery, Cincinnati.

23). Miccoli P. Minimally invasive surgery for thyroid and parathyroid diseases. Surg Endosc. 2002; 16:3–6.

24). Dralle H, Sekulla C, Haerting J, Timmermann W, Neumann HJ, Kruse E, et al. Risk factors of paralysis and functional outcome after recurrent laryngeal nerve monitoring in thyroid surgery. Surgery. 2004; 136:1310–22.

25). Gossot D. Ultrasonic dissectors in endoscopic surgery. Ann Chir. 1998; 52:635–42.

26). Boddy SA, Ramsay JW, Carter SS, Webster PJ, Levison DA, Whitfield HN. Tissue effects of an ultrasonic scalpel for clinical surgical use. Urol Res. 1987; 15:49–52.

27). Anonymous (1999) Ligasure vessel sealing system user's manual. Valleylab, Covidien, Boulder.

28). Manouras A, Markogiannakis H, Koutras AS, Antonakis PT, Drimousis P, Lagoudianakis EE. Thyroid surgery: comparison between the electrothermal bipolar vessel sealing system, harmonic scalpel, and classic suture ligation. Am J Surg. 2008; 195:48–52.

29). Sartori PV, De Fina S, Colombo G, Pugliese F, Romano F, Cesana G, et al. Ligasure versus Ultracision in thyroid surgery: prospective randomized study. Langenbecks Arch Surg. 2008; 393:655–8.