A COMPARATIVE STUDY OF FOCUS HARMONIC SCALPEL VERSUS CONVENTIONAL VASCULAR LIGATURE TECHNIQUE IN PATIENTS UNDERGOING TOTAL THYROIDECTOMY

Authors

  • Imran Khan Army Medical Corps
  • Muhammad Saeed Akhtar Army Medical Corps
  • Nadia Bibi Khyber Medical University, Peshawar-Pakistan
  • Rehan Haider Army Medical Corps
  • Fahad Gul Army Medical Corps
  • Kamran Safdar Army Medical Corps

DOI:

https://doi.org/10.55519/JAMC-01-12290

Keywords:

Harmonic; Ligature; Thyroidectomy; Vascular

Abstract

Background: Thyroid surgery is one of most commonly employed procedures by the surgeons. Evolution of the technique was based on different techniques employed during the dissection of the thyroid tissue, control of bleeding to ensure hemostasis and nerve monitoring with the aim to decrease the complications during the intraoperative and the post operative period. Objective was to compare total thyroidectomy with FOCUS Harmonic scalpel with conventional vascular ligature technique in patients undergoing total thyroidectomy. It was a randomized controlled Trial conducted at the CMH Bahawalpur from 1st July to 31st Dec 2022 (6 Months). Methods: A total number of 78 patients who were planned for total thyroidectomy were included in the trial. Employing a non-probability consecutive sampling technique via lottery method 39 patients were assigned to either of the 02 groups, i.e., Group A (harmonic scalpel technique) and Group B (conventional vascular ligature technique). Recorded variables included mean operative time, intraoperative and postoperative blood loss. Demographic characteristics and ASA grade were recorded for each patient. Results: Mean age of the patients in Group A was 44.05±6.37 years while 44.79±7.62 years in Group B. Male to female ratio was 1:2 among the total participants with 26 (33.3%) males and 52 (66.7%) females however male participants in both groups were 11 (28.2%) versus 15 (38.5%) and females were 28 (71.8%) versus 24 (61.5%) respectively. Harmonic scalpel technique showed significant results in terms of mean operative time, intraoperative and post operative blood loss as compared to conventional vessel ligature technique with a p<0.05. Conclusion: In terms of mean operative time, intraoperative and postoperative blood loss Harmonic scalpel technique is superior to conventional vascular ligature technique for total thyroidectomy.

References

1. Benhidjeb T, Witzel K, Schulte am Esch J, Stark M, Shaear M, Tufano RP. History and Evolution of Transoral Thyroidectomy Approach. Transoral Neck Surg 2020;2020:1–15.

2. Patel KN, Yip L, Lubitz CC, Grubbs EG, Miller BS, Shen W, et al. The American Association of Endocrine Surgeons guidelines for the definitive surgical management of thyroid disease in adults. Ann Surg 2020;271(3):e21–93.

3. Mu L, Ren C, Xu J, Guo C, Huang J, Ding K. Total versus near-total thyroidectomy in Graves’ disease: a systematic review and meta-analysis of comparative studies. Gland Surg 2021;10(2):729.

4. Schneider R, Machens A, Lorenz K, Dralle H. Intraoperative nerve monitoring in thyroid surgery—shifting current paradigms. Gland Surg 2020;9(Suppl 2):S120–8.

5. Li X, Zhang B, Yu L, Yang J, Tan H. Influence of sevoflurane-based anesthesia versus total intravenous anesthesia on intraoperative neuromonitoring during thyroidectomy. Otolaryngol Head Neck Surg 2020;162(6):853–9.

6. Abdulmageed MU, Katoof FM, Abdullah AA. Comparison study between the usage of harmonic scalpel versus classical suture method for thyroidectomy in Iraqi patients. J Pak Med Assoc 2021;71(12):S40–4.

7. Chahardahmasumi E, Salehidoost R, Amini M, Aminorroaya A, Rezvanian H, Kachooei A, et al. Assessment of the early and late complication after thyroidectomy. Adv Biomed Res 2019;8:14.

8. Ali M, Murtaza M, Aleem-ud-Din M, ud Din MB, Sarwar A, Aslam A. Comparison of Harmonic Scalpel versus conventional hemostasis in Thyroid surgery in terms of per-operative and postoperative outcome. Prof Med J 2020;27(01):68–73.

9. Bhettani MK, Rehman M, Khan MS, Altaf HN, Khan KH, Farooqui F, et al. Safety and cost-effectiveness of LigaSure® in total thyroidectomy in comparison with conventional suture tie technique. Cureus 2019;11(12):e6368.

10. Jamil A, Javed R, Ashraf S, Amin I, Shakoor S, Laique T. Comparison of Harmonic Scalpel Method with Conventional Procedure for Hospital Stay During Thyroidectomy among Pakistani Patients. Pak J Med Sci 2019;13(4):1296–8.

11. Ahmad D, Imran K, Shakil S. Harmonic scalpel compared to conventional homeostasis in thyroid surgery. Pak J Med Health Sci 2018;12(1):46–9.

12. Wojtczak B, Aporowicz M, Kaliszewski K, Bolanowski M. Consequences of bleeding after thyroid surgery - analysis of 7805 operations performed in a single center. Arch Med Sci 2018;14(2):329–35.

13. Chin J, Zhou Y, Wan PJ, Lomiguen CM. The prevalence of thyroid ima artery and its clinical significance. Int J Otorhinolaryngol Head Neck Surg 2019;5(4):845–9.

14. Baseer A, Bilal A, Imran M. Use of Harmonic Scalpel in Open thoracic surgery. Pak J Chest Med 2011;17(4):1–6.

15. Ahmad MS, Khalid N, Mahl FS, Ali F. Comparison between postoperative drain output after thyroidectomy with and without use of harmonic scalpel device. Pak Postgrad Med J 2019;30(03):91–4.

16. Shakoor S, Yar MA, Nawaz B. Comparison between conventional and harmonic techniques in bleeding control during Thyroidectomy. J Med Phys Biophys 2019;54:61–5.

17. Almarzuik A, DNM TS. Harmonic knife new haemostatic procedure in thyroid surgery. Al-Kindy Coll Med J 2017;13(1):142–5.

18. Badak B, Fezan SM. Comparison of The Safetyness of Energy Based Devices (Electrotome, Harmonic and Ligasure) in Thyroid Surgery. J Surg Sci Oper Care 2018;1:104.

19. Chahardahmasumi E, Salehidoost R, Amini M, Aminorroaya A, Rezvanian H, Kachooei A, et al. Assessment of the early and late complication after thyroidectomy. Adv Biomed Res 2019;8(1):14.

20. Spartalis E, Giannakodimos A, Ziogou A, Giannakodimos I, Paschou SA, Spartalis M, et al. Effect of energy-based devices on post-operative parathyroid function and blood calcium levels after total thyroidectomy. Expert Rev Med Devices 2021;18(3):291–8.

21. Salami A, Dellepiane M, Bavazzano M, Crippa B, Mora F, Mora R. New trends in head and neck surgery: A prospective evaluation of the Harmonic Scalpel®. Med Sci Monit 2008;14(5):PI1–5.

22. Saloom AK, AbdulJabbar MQ. Comparative study between Harmonic FOCUSTM to clamp and tie technique for total thyroidectomy. J Fac Med Baghdad 2016;58(3):241–4.

Published

2025-04-15

How to Cite

1.
Khan I, Akhtar MS, Bibi N, Haider R, Gul F, Safdar K. A COMPARATIVE STUDY OF FOCUS HARMONIC SCALPEL VERSUS CONVENTIONAL VASCULAR LIGATURE TECHNIQUE IN PATIENTS UNDERGOING TOTAL THYROIDECTOMY. J Ayub Med Coll Abbottabad [Internet]. 2025 Apr. 15 [cited 2025 Jul. 19];37(1). Available from: https://www.jamc.ayubmed.edu.pk/index.php/jamc/article/view/12290