Luca Revelli1, Gianfranco Damiani2, Caterina Bianca Neve Aurora Bianchi3, Serafino Vanella4, Walter Ricciardi5, Marco Raffaelli6, Celestino Pio Lombardi7. 1. Department of Surgical Sciences, University Hospital Agostino Gemelli, Catholic University of Sacred Heart, Rome, Italy. Electronic address: luca.revelli@unicatt.it. 2. Department of Public Health, University Hospital Agostino Gemelli, Catholic University of Sacred Heart, Rome, Italy. Electronic address: gdamiani@rm.unicatt.it. 3. Cooperative OSA Onlus, Associated Health Care Workers, Rome, Italy. Electronic address: caterinablanc@gmail.com. 4. Department of Surgical Sciences, University Hospital Agostino Gemelli, Catholic University of Sacred Heart, Rome, Italy. Electronic address: nekroma@yahoo.it. 5. Department of Public Health, University Hospital Agostino Gemelli, Catholic University of Sacred Heart, Rome, Italy. Electronic address: wricciardi@rm.unicatt.it. 6. Department of Surgical Sciences, University Hospital Agostino Gemelli, Catholic University of Sacred Heart, Rome, Italy. Electronic address: marco.raffaelli@unicatt.it. 7. Department of Surgical Sciences, University Hospital Agostino Gemelli, Catholic University of Sacred Heart, Rome, Italy. Electronic address: celestinopio.lombardi@unicatt.it.
Abstract
BACKGROUND: To evaluate the incidence of postoperative complications, hemostatic effects and safety of Total Thyroidectomy (TT) performed using the Harmonic Scalpel (HS), the Harmonic Focus (HF) or Conventional Hemostasis (CH). METHODS: The meta-analysis was performed according to PRISMA guidelines. A literature search was conducted from 2003 to 2014 and stringent criteria were required for inclusion. Thirteen studies concerning an overall population of 1458 compared HS versus CH, whilst 8 studies with 1667 patients compared HF versus CH. RESULTS: There was a significant reduction of operative time (Mean Difference [MD] = -25.49 min.; 95% CI -32.43 to -18.55), intraoperative blood loss (MD = -30.49 mL; 95% CI -53.01 to -7.97), postoperative drainage volume (MD = -12.90 mL; 95% CI -22.83 to -2.98) and postoperative pain (MD = -0.87; 95% CI -1.27 to -0.46) in patients underwent TT with HS. Regarding HF group, a significant reduction of operative time (MD = -25.99 min., 95% CI -34.56 to -17.41), length of hospital stay (MD = -0.57; 95% CI -0.97 to -0.17), transient hypocalcemia (OR = 0.56; 95% CI 0.39 to 0.81) and postoperative pain (MD = -1.33 days; 95% CI -2.49 to -0.17) resulted. CONCLUSIONS: HS TT can be a safe, useful and fast alternative to conventional TT. The newer HF can reduce the rate of hypocalcemia. Future RCTs of larger patient cohorts with more detailed data of postoperative complications, cost-effectiveness and cosmetic results, randomization procedures, intention-to-treat analyses and blinding of outcome assessors are needed to draw more meaningful conclusions.
BACKGROUND: To evaluate the incidence of postoperative complications, hemostatic effects and safety of Total Thyroidectomy (TT) performed using the Harmonic Scalpel (HS), the Harmonic Focus (HF) or Conventional Hemostasis (CH). METHODS: The meta-analysis was performed according to PRISMA guidelines. A literature search was conducted from 2003 to 2014 and stringent criteria were required for inclusion. Thirteen studies concerning an overall population of 1458 compared HS versus CH, whilst 8 studies with 1667 patients compared HF versus CH. RESULTS: There was a significant reduction of operative time (Mean Difference [MD] = -25.49 min.; 95% CI -32.43 to -18.55), intraoperative blood loss (MD = -30.49 mL; 95% CI -53.01 to -7.97), postoperative drainage volume (MD = -12.90 mL; 95% CI -22.83 to -2.98) and postoperative pain (MD = -0.87; 95% CI -1.27 to -0.46) in patients underwent TT with HS. Regarding HF group, a significant reduction of operative time (MD = -25.99 min., 95% CI -34.56 to -17.41), length of hospital stay (MD = -0.57; 95% CI -0.97 to -0.17), transient hypocalcemia (OR = 0.56; 95% CI 0.39 to 0.81) and postoperative pain (MD = -1.33 days; 95% CI -2.49 to -0.17) resulted. CONCLUSIONS:HS TT can be a safe, useful and fast alternative to conventional TT. The newer HF can reduce the rate of hypocalcemia. Future RCTs of larger patient cohorts with more detailed data of postoperative complications, cost-effectiveness and cosmetic results, randomization procedures, intention-to-treat analyses and blinding of outcome assessors are needed to draw more meaningful conclusions.
Authors: Gian Luigi Canu; Fabio Medas; Francesco Podda; Alberto Tatti; Giuseppe Pisano; Enrico Erdas; Pietro Giorgio Calò Journal: Gland Surg Date: 2020-06
Authors: Hang Cheng; Jeffrey W Clymer; Behnam Sadeghirad; Nicole C Ferko; Chris G Cameron; Joseph F Amaral Journal: World J Surg Oncol Date: 2018-01-04 Impact factor: 2.754
Authors: Hang Cheng; Jeffrey W Clymer; Rana A Qadeer; Nicole Ferko; Behnam Sadeghirad; Chris G Cameron; Joseph F Amaral Journal: Clinicoecon Outcomes Res Date: 2018-07-24