Harmonic Scalpel Versus Electro-coagulation In Thyroid Surgery:a Systematic Review

Background:The most effective treatment of the thyroid nodules is surgery.The surgical complications include bleeding and the next tissue damage, thyroid is rich in blood vessels, and have high blood pressure, the surgery have a narrow operative field, effective hemostasis must be done to avoid surgery vision bleeding caused operating difficulties and postoperative bleeding. Which need surgical procedures operating fine, while suitable equipment and technique is also an important factor. The traditional jaw, hemostasis operation is time consuming, then the advent of electro-coagulation make the operation simplified.and the effect on the small blood vessels is greatly improved.But its security is still worth to exploring. Harmonic scalpel was firstly used in surgery since1991.and then was used in opening surgery. After that the harmonic scalpel with5mm head was used in more delicate operation such as laparoscopic. Since then, this surgical instruments have been use in different surgical.Objective:To assess the safety of the harmonic scalpel versus electrosurgical in thyroid surgery.Method:We searched PubMed, Embase, the Cochrane Library, ISI Web of Knowledge, Chinese biomedicine literature database, Chinese journal full-text database, Chinese scientific journal full-text database of retrieved, randomized controlled trials comparing harmonic scalpel with electrosurgical in thyroid surgery. Two reviewers independently assessed the quality of included studies. Meta-analysis was performed using RevMan5.1software.Result:Ten prospective randomized controlled trials were included in this meta-analysis (n=964). there was significant difference in mean operating time reduction for the harmonic scalpel was equivalent to22.07minutes (WMD=-22.07,95%CI:-30.00～14.14, P<0.05);When harmonic scalpel was used,blood loss was reduced significantly(WMD=-18.32,95%CI:-23.03～13.61,P<0.05);There was no difference in the incidence of transient RLND(OR=1.06,95%CI:0.42-2.69, P=0.91),but a lower rate of transient hypocalcaemia with the use of the HS (OR=0.33,95%CI:0.20-0.55, P<0.05)Conclusion:Current evidence suggests that compared to electro-coagulation, harmonic scalpel in thyroidectomy can shorten the operation time, reduce bleeding, reduce postoperative drainage,while reducing postoperative complications hypocalcaemia, shorter hospital stays.