Harmonic focus in thyroidectomy for substernal goiter

OBJECTIVES: No previous prospective study has evaluated harmonic scalpel in thyroidectomy for substernal goiter. The objective of this study was to evaluate the use of harmonic scalpel (FOCUS shear, Ethicon Endo-Surgery) in thyroidectomy for substernal goiter for blood loss, operative time, hospital stay and complications.

MATERIALS AND METHODS: Prospective non-randomised study of 242 consecutive patients with substernal goiter out of 2258 patients (11%) who underwent thyroidectomy. A total of 121 patients had thyroidectomy performed with bipolar electrocoagulation and knot-tying techniques and 121 patients had harmonic scalpel thyroidectomy.

RESULTS: The use of harmonic scalpel was associated with significant reduction in intraoperative blood loss (50 vs. 100mL, p=0.001), postoperative haemorrhage (4% vs. 12%, p=0.03) and length of hospital stay (2 vs. 3 days, p=0.001). The mean operative time was significantly longer in the harmonic group.

CONCLUSION: Harmonic scalpel is a safe tool for thyroidectomy for substernal goiter. Its utilisation is associated with reduced blood loss, lower incidence of postoperative haemorrhage and shorter hospital stay.