Koutsoumanis Konstantinos, Koutras Athanasios S, Drimousis Panagiotis G, Stamou Konstantinos M, Theodorou Dimitrios, Katsaragakis Stylianos, Bramis John
Department of Endocrine Surgery, First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocratio Hospital, Athens, Greece.
Am J Surg. 2007 Jun;193(6):693-6. doi: 10.1016/j.amjsurg.2006.06.049.
Hemostasis in thyroid surgery is of utmost importance for a successful surgery and an uneventful postoperative course. The present article reports a single surgeon's 3-year experience in the use of the harmonic scalpel. The device was developed in the early 1990s and offered adequate and safe hemostasis for vessels up to 3 mm in width.
This was a prospective observational study. Data sheets from all patients who had surgery by a single endocrine surgeon in the period from 1999 to 2004 were evaluated. Patients were divided into 3 groups based on the surgical technique used: group I comprised the conventional knot-and-tie technique, group II comprised the ligation of all but the superior thyroid vessels with a scalpel, and group III comprised patients in whom the device was used exclusively. The groups were compared in regard to surgical time, cost, and complication rate.
A total of 272 patients were included in the study: 107 patients were included in group I, 77 in group II, and 88 group III. The surgical time of group I differed significantly compared with groups II and III (P < .0001 in both cases). Surgical times between groups II and III did not differ significantly (P = .701).
The use of the harmonic scalpel reduces surgical time, but it increases the cost of the surgery. It is our belief that by including in the absolute cost the time saved and the reduction in human resources needed, the use of the scalpel would prove to be economic.
甲状腺手术中的止血对于手术成功及术后顺利恢复至关重要。本文报告了一位外科医生使用超声刀的3年经验。该设备于20世纪90年代初研发，可为宽度达3毫米的血管提供充分且安全的止血效果。
这是一项前瞻性观察性研究。对1999年至2004年期间由一位内分泌外科医生进行手术的所有患者的数据表进行评估。根据所采用的手术技术将患者分为3组：第一组采用传统的打结结扎技术，第二组采用手术刀结扎除甲状腺上血管外的所有血管，第三组仅使用该设备。对三组在手术时间、成本和并发症发生率方面进行比较。
共有272例患者纳入研究：第一组107例，第二组77例，第三组88例。第一组的手术时间与第二组和第三组相比有显著差异（两种情况均P <.000）。第二组和第三组之间的手术时间无显著差异（P =.701）。
使用超声刀可缩短手术时间，但会增加手术成本。我们认为，将节省的时间和所需人力资源的减少纳入绝对成本中，使用超声刀将证明是经济的。
