Journal List > Korean J Endocr Surg > v.17(1) > 1060177

Kim, Kim, and Kim: Total Thyroidectomy with Central Neck Dissection Using Harmonic Focus: A Randomized Clinical Trial

Abstract

Purpose

The use of sealing devices such as Harmonic scalpel and Ligasure is increasing steadily in thyroid surgery. The Harmonic Focus (HF) is an ultrasonic device that enables simultaneous vessel sealing and tissue coagulation, designed for open surgery such as thyroidectomy. The aim of this study is to assess the efficiency and safety of HF use in thyroid surgery compared to Conventional Tying (CT).

Methods

A prospective study was conducted to compare the efficacy of HF versus CT. We evaluated 50 patients who underwent surgery for thyroid tumor at Korea University Anam Hospital. All patients underwent total thyroidectomy with central neck dissection after being randomly allocated into two groups: HF group and CT group. The differences in surgical outcomes and postoperative complications by device use, i.e. group assignment, were statistically analyzed.

Results

There were no differences in number of retrieved lymph nodes (P=0.595), number of resected parathyroid glands (P=0.330), immediate postoperative iPTH (P=0.252), length of hospitalization (P=0.375) between HF group and CT group. However, operative time was shorter in HF group than CT group (106.07±20.92 min vs. 136.54±38.24 min, P=0.046). Postoperative complications of wound infection, seroma, hematoma, chyle leakage, vocal cord palsy, and hypoparathyroidism did not differ between groups.

Conclusion

HF is a safe, effective, and time-saving technique; outcomes are comparable with CT. Both intraoperative and postoperative variables were similar between groups. Future larger studies are warranted to further investigate the effect on postoperative complications.

Figures and Tables

Fig. 1

Comparison of study flow diagram.

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Table 1

Comparison of the preoperative characteristics between the harmonic focus (HF) group and the conventional tying (CT) group

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Characteristics HF (n=25) CT (n=25) P value
Age (years) 54.16±12.18 48.40±12.03 0.747
Gender 0.733
 Female 19 (76.0%) 20 (80.0%)
 Male 6 (24.0%) 5 (20.0%)
BMI (kg/m2) 23.14±3.44 24.73±3.61 0.394
T3 115.26±23.70 114.92±28.17 0.252
fT4 1.30±0.26 1.66±6.82 0.561
TSH 2.06±1.20 2.11±1.90 0.474
Size of dominant nodule on ultrasounds (cm) 0.95±0.76 1.14±0.88 0.204

BMI = body-mass index; TSH = thyroid stimulating hormone.

Table 2

Comparison of the surgical outcomes between the harmonic focus (HF) group and the conventional tying (CT) group

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Characteristics HF (n=25) CT (n=25) P value
Total operation time (min) 106.07±20.92 136.54±38.24 0.046
Length of hospitalization (days) 3.41±1.00 3.22±0.67 0.375
Size of tumor (pathological) 0.79±0.80 0.78±0.33 0.717
Permanent pathology 0.455
 Benign 2 (8.0%) 3 (12.0%)
 Malignancy 23 (92.0%) 22 (88.0%)
T stage 0.533
 T0 2 (8.0%) 3 (12.0%)
 T1 14 (56.0%) 16 (64.0%)
 T3 9 (36.0%) 6 (24.0%)
Number of resected PTG 0.330
 0 19 (76.0%) 22 (88.0%)
 1 6 (24.0%) 2 (8.0%)
 2 0 1 (4.0%)
Multiplicity 0.319
 Single 17 (68.0%) 21 (84.0%)
 Multifocal, unilateral 3 (12.0%) 3 (12.0%)
 Multifocal, bilateral 5 (20.0%) 1 (4.0%)
Number of metastatic lymph nodes 1.24±2.13 0.67±1.32 0.374
Number of retrieved lymph nodes 10.55±4.98 7.06±5.73 0.595
Immediate postoperative iPTH 17.34±12.28 13.74±12.21 0.252

PTG = parathyroid gland.

Table 3

Comparison of the postoperative morbidities between the harmonic focus (HF) group and the conventional tying (CT) group

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Characteristics HF (n=25) CT (n=25) P value
Transient hypoparathyroidism
 Immediate: 2 weeks 7 (28.0%) 6 (24.0%) 0.747
 Delayed: 3 months 3 (12.0%) 2 (8.0%) 0.637
Permanent hypoparathyroidism 1 (4.0%) 0 0.312
Vocal cord palsy*
 2 weeks 0 0 -
 3 months 0 0 -
Hematoma 0 0 -
Wound infection 0 0 -
Seroma 1 (4.0%) 1 (4.0%) 1.000

*Vocal cord palsy is described as number (fixed on stroboscopy/edematous vocal cord on stroboscopy).

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