Hemostasis in thyroid surgery: Harmonic scalpel versus other techniques-a meta-analysis

OBJECTIVE: The objective is to systematically review the literature studying the harmonic scalpel versus other hemostatic techniques in thyroid surgical patients. Although thyroidectomy is one of the most common surgical procedures, the safest, most efficient, and cost-effective way to achieve hemostasis is hotly debated. DATA SOURCES: We searched the electronic databases Medline and the Cochrane Library using relevant search strategies. REVIEW METHODS: Two reviewers (G.W., T.E.) independently assessed titles and abstracts of 72 identified studies. Twelve prospective randomized controlled studies were considered relevant and included in this meta-analysis (1153 patients). RESULTS: In all studies, operating time was reduced by using the harmonic scalpel. Compared with surgical hemostasis by suture ligation or suture/clip ligation combined with electrocauterization or electrothermal bipolar vessel sealer (n = 602), the mean operating time reduction for the harmonic scalpel was equivalent to 22.67 minutes (95% CI, -27.98; -17.37, P < 0.00001) or nearly 25 percent of the total operating room time. When harmonic scalpel was used, blood loss was reduced significantly by 20.03 mL (95% CI, -27.83; -12.22, P < 0.00001), and a mean reduction in postoperative pain (0.86 points [95% CI, -1.60; -0.13, P = 0.02]) was measured. Length of stay was reduced by 0.12 days (95% CI, -0.25; 0.00, P = 0.05). Differences regarding volume of drainage fluid were in favor of harmonic scalpel but not statistically significant; complications were similar in both groups. CONCLUSION: There is clear evidence that using the harmonic scalpel for hemostasis in thyroid surgery significantly reduces operating time and blood loss and that it is not associated with an increase in volume of drainage fluid, complication rate, or hospital stay. (C) 2010 American Academy of Otolaryngology-Head and Neck Surgery Foundation. All rights reserved.