COMPARISON OF THE EFFECTS OF FOCUS HARMONIC SCALPEL AND CONVENTIONAL HAEMOSTASIS ON PARATHYROID FUNCTION IN THYROID SURGERY
Abstract
Background: Protection of parathyroid is very important in thyroid surgery. Our aim was to compare the effect of Focus Harmonic Scalpel and Conventional Haemostasis on parathyroid function in thyroid surgery. Methods: To analyse the clinical data of patients in our hospital from November 2011～December 2015 retrospectively. Operations has been performed with Focus Harmonic Scalpel in thyroid surgery since May 2013. Seventy-four patients with nodular goitre constituted Harmonic Scalpel group and Conventional Haemostasis group, and so did 139 patients with thyroid papillary carcinoma. Clinical data were compared such as age, gender, thyroid volume, operation procedure, preoperative parathyroid hormone and serum calcium concentration between the two groups. The differences between the two groups were observed in serum calcium concentration, parathyroid hormone concentration, incidence of transient hypocalcaemia and hypoparathyroidism after operation. Results: The preoperative data showed no significant difference between Harmonic Scalpel group and Conventional Haemostasis group. No significant difference existed in postoperative clinic data at six a.m. the first day after operation between the two groups for patients with nodular goitre. The incidence of transient hypoparathyroidism and hypocalcaemia in Harmonic Scalpel group were less than that in Conventional Haemostasis group in thyroid surgery. Significant differences existed in the mean of serum calcium concentration and incidence of transient hypocalcaemia between the two groups for thyroid papillary carcinoma statistically. Conclusions: Focus Harmonic Scalpel has certain advantages than conventional Haemostasis in protecting parathyroid glands, reducing the incidence of transient hypoparathyroidism and hypocalcaemia in thyroid surgery, especially for patients with thyroid cancer.
Keywords: Thyroidectomy; Focus Harmonic Scalpel; Hypoparathyroidism; HypocalcaemiaReferences
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Markogiannakis H, Kekis PB, Memos N, Alevizos L, Tsamis D, Michalopoulos NV, et al. Thyroid surgery with the new harmonic scalpel: a prospective randomized study. Surgery 2011;149(3):411-5.
Bandi G, Wen CC, Wilkinson EA, Hedican SP, Moon TD, Nakada SY. Comparison of blade temperature dynamics after activation of Harmonic Ace scalpel and the Ultracision Harmonic Scalpel LCS-K5. J Endourol 2008;22(2):333-6.
Ferri E, Armato E, Spinato G, Spinato R. Focus Harmonic Scalpel Compared to Conventional Haemostasis in Open Total Thyroidectomy: A Prospective Randomized Trial. Int J Otolaryngol 2011;2011(9):357195.
Yano Y, Masaki C, Sugino K, Nagahama M, Kitagawa W, Sibuya H, et al. Serum intact parathyroid hormone level after total thyroidectomy or total thyroidectomy plus lymph node dissection for thyroid nodules:report from 296 surgical cases. Int J Endocrinol Metab 2012;10(4):594-8.
Pelizzo MR, Sorgato N, Isabella Merante Boschin I, Marzola MC, Colletti PM, Rubello D. Does the ultrasound dissector improve parathyroid gland preservation during surgery? Eur J Surg Oncol 2014;40(7):865-8.
Duan YF, Xue W, Zhu F, Sun DL. FOCUS harmonic scalpel compared to conventional hemostasis in open total thyroidectomy-a prospective randomized study. J Otolaryngol Head Neck Surg 2013;20(42):62-6.
Grodski S, Serpell J. Evidence for the role of perioperative PTH measurement after total thyroidectomy as a predictor of hypocalcemia. World J Surg 2008;32(7):1367-73.
De Palma M, Rosato L, Zingone F, Orlando G, Antonino A, Vitale M, et al. Post-thyroidectomy complications. The role of the device: bipolar vs ultrasonic device: Collection of data from 1,846 consecutive patients undergoing thyroidectomy. Am J Surg 2016;212(1):116-21.
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Lorente-Poch L, Sancho JJ, Ruiz S, Sitges-Serra A. Importance of in situ preservation of parathyroid glands during total thyroidectomy. Br J Surg 2015;102(4):359-67.
Trupka A, Sienel W. Autotransplantation of at least one parathyroid gland during thyroidectomy in benign thyroid disease minimizes the risk of permanent hypoparathyroidism. Zentralbl Chir 2002;127(5):439-42.
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