Saadia Muhammad Ali, Jahangir Sarwar Khan, Muhammad Mussadiq Khan.
Harmonic Scalpel vs. Knot tying in open Thyroidectomy.
Ann Pak Inst Med Sci Jan ;10(1):50-3.

Objectives: To determine the mean operative time, total amount of drainage, post operative hematoma formation and incidence of recurrent laryngeal nerve palsy in patients undergoing thyroid surgery with harmonic scalpel verses knot tying. Study Design: Randomized clinical trial. Place and Duration: Surgical Unit l, Holy Family Hospital, Rawalpindi (A tertiary care unit) Materials and Methods: During the one year period, 60 patients were admitted from the OPD (30 in each group) using consecutive (non-probability) sampling technique. The target population was the patients attending the surgical OPD unit l. After an informed consent, the patients who fulfilled the selection criteria were selected for the study in consecutive order by the doctor in the OPD. Lottery method was used for the distribution of patients in the two groups. The procedure was performed by the consultant surgeons of SUI at Holy Family Hospital. Operative time, total amount of drainage, post operative hematoma formation and incidence of recurrent laryngeal nerve palsy were noted and findings were recorded on a Performa. All data was analyzed which helped to determine whether the use of harmonic scalpel in thyroidectomy reduced the operative time or not, as well as whether its use reduced the incidence of post operative drainage, post operative hematoma formation, and the incidence of recurrent laryngeal nerve palsy, as compared to the surgery in which sutures were used for haemostasis. Results: The mean operative time in the harmonic scalpel group (G 1) was 81.93 minutes, and that in the knot and tie group (G 2) was 106.80 minutes, and the difference was statistically significant. The post operative drainage is also less in G1 (47ml) as compared to G2 (94ml), with a statistically significant difference. Harmonic scalpel is also not associated with increase in the rate of post operative hematoma formation and the incidence of recurrent laryngeal nerve palsy. Conclusion: Mean operating time and post operative drainage fluid is less with the use of Harmonic scalpel device is less as compared to that with knot tying during open thyroid surgery for multinodular goiter, without increase in the incidence of post operative. hematoma formation and recurrent laryngeal nerve palsy.

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