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The Harmonic Scalpel Technique Without Supplementary Ligation in Total Thyroidectomy with Central Neck Dissection: A Prospective Randomized Study

Koh, Yoon Woo MD*; Park, Jae Hong MD*; Lee, Seung Won MD*; Choi, Eun Chang MD, PhD

doi: 10.1097/SLA.0b013e31816bcd61
Randomized Controlled Trial

Objective: To investigate the safety and efficacy of the no-tie (NT) technique using the harmonic scalpel (HS) in terms of the operating time and complications in total thyroidectomy with central neck dissection (CND).

Summary Background Data: Recently, the HS has been used as an alternative to conventional hand-tied ligation for hemostasis in thyroid surgery, which is a time-consuming procedure. Limited data have been published on the evidence of its safety in total thyroidectomy accompanied by CND without supplementary hand-tied ligation.

Methods: Sixty-five consecutive thyroidectomized patients were enrolled in this study. The final pathology in all the patients was thyroid papillary carcinoma. All patients underwent total thyroidectomy with CND. The NT technique using HS group consisted of 31 patients. The conventional hand-tied ligation technique group comprised 34 patients. The following variables were examined: operating time, intraoperative bleeding, incidence of perioperative complications (hemorrhage, hematoma, seroma, recurrent laryngeal nerve palsy, hypoparathyroidism, and injury to the adjacent structures including the trachea and esophagus), the number of pathologically proven lymph nodes, total amount of drainage, duration of drain placement, and time of hospital discharge.

Results: The use of the HS reduced the operating time of total thyroidectomy with CND by an average of 43.12 minutes (P < 0.001). The number of pathologically proven lymph nodes was 7.32 ± 1.66 in the NT group and 6.85 ± 1.76 in the CT group (P = 0.274). No significant difference was observed in the overall perioperative complications, such as postoperative bleeding, temporary recurrent laryngeal nerve palsy, and temporary hypoparathyroidism, between the 2 groups. No permanent recurrent laryngeal nerve palsy and hypoparathyroidism occurred in either group.

Conclusions: The NT technique with the HS is a relatively safe and effective method in total thyroidectomy combined with CND. Moreover, the HS significantly reduced the operating time.

Application of the no-tie technique using the harmonic scalpel is a relatively safe method, even in total thyroidectomy combined with central neck dissection, and it reduces the operating time by simultaneously ligating and cutting the vessels with sufficient hemostasis.

From the *Department of Otolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Bucheon, Korea; and †Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea.

This study has been registered in

Reprints: Eun Chang Choi, MD, PhD, Department of Otorhinolaryngology, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemun-gu, Seoul 120-752, Korea. E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.