Minimally invasive video-assisted thyreoidectomy (mivat) with and without use of harmonic scalpel—a randomized study

Abstract
Background and aims  Minimally invasive video-assisted thyroidectomy (MIVAT) has been used for the removal of small thyroid nodules to improve
cosmetic results and diminish pain. The aim of this study was to compare the outcomes of the MIVAT operations with and without
the use of an ultrasonic harmonic scalpel (HS).

Patients and methods  Seventy-six patients with a solitary thyroid nodule below 30 mm in diameter were randomized to two groups of 38 patients each.
Unilateral thyroid lobectomy was performed in each patient. In the clip-ligation group (CL-G), during MIVAT, the superior
thyroid vessels were clipped and bipolar coagulation was used to secure smaller vessels, whereas in the harmonic scalpel group
(HS-G), HS was used to dissect and divide all the thyroid vessels. The statistical analysis included the mean operative time,
blood loss, postoperative morbidity, scar length, cosmetic satisfaction at 1 and 6 months following surgery, and cost-effectiveness.

Results  HS-G vs CL-G operations were shorter (31.4 ± 7.7 vs 47.5 ± 13.2 min; p < 0.001), the mean blood loss was smaller (12.9 ± 5.7 vs 32.8 ± 13.0 ml; p < 0.001), the mean scar length at 1 month following surgery was shorter (15.6 ± 1.4 vs 21.5 ± 1.9 mm; p < 0.001), and greater cosmetic satisfaction was achieved at 1 month after surgery (88.9 ± 9.7 vs 81.9 ± 5.4 pts; p < 0.001), but the difference became nonsignificant at 6 months postoperatively. MIVAT with HS was 20–30 euros more expensive.
No major complications were observed in both groups.

Conclusions  HS in the MIVAT operations is safe and facilitates dissection, allowing for a significant decrease in operative time. Other
benefits, such as lower blood loss, a scar a few millimeters shorter, or a slightly better early cosmetic result, are offered
at slightly increased costs.

Content Type Journal ArticleCategory Controlled Prospective Clinical TrialsDOI 10.1007/s00423-008-0373-8Authors
Marcin Barczyński, Jagiellonian University College of Medicine Department of Endocrine Surgery, 3rd Chair of General Surgery 37 Prądnicka Street 31-202 Kraków PolandAleksander Konturek, Jagiellonian University College of Medicine Department of Endocrine Surgery, 3rd Chair of General Surgery 37 Prądnicka Street 31-202 Kraków PolandStanisław Cichoń, Jagiellonian University College of Medicine Department of Endocrine Surgery, 3rd Chair of General Surgery 37 Prądnicka Street 31-202 Kraków Poland

Journal Langenbeck's Archives of SurgeryOnline ISSN 1435-2451Print ISSN 1435-2443 (Source: Langenbeck's Archives of Surgery)  MedWorm Sponsored Message: Find out how you can get your message across here by sponsoring this MedWorm news feed.