Department of Otolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Bucheon, Korea.
Surg Endosc. 2010 May;24(5):1117-25. doi: 10.1007/s00464-009-0738-2. Epub 2009 Dec 8.
The harmonic scalpel (HS) has been used in endoscopic thyroidectomy with encouraging results. However, additional instruments are frequently required to complete hemostasis. The current study aimed to assess the safety and efficacy of the clipless and sutureless technique using the HS in endoscopic thyroidectomy without supplementary instrumentation.
A total of 114 patients underwent endoscopic hemithyroidectomy (HT) or total thyroidectomy (TT) via a unilateral axillo-breast approach. In all cases, hemostasis was achieved solely by the HS. Perioperative complications, surgery-related outcomes, and pathologic outcomes were examined.
The operating time in the TT group (170.23 +/- 45.63 min; n = 22) was longer than in the HT group (111.63 +/- 38.44 min; n = 92; p = 0.0000). After the first 50 cases, the operating time decreased significantly (145.60 +/- 52.72 min vs. 105.23 +/- 30.14 min, p = 0.0000). Postoperative minor hematomas from the skin flap were experienced by three patients (3.3%) in the HT group. No postoperative hemorrhage or hematoma was noted in the thyroidectomy field using the HS. Four patients in the HT group (4.3%) and one patient in the TT group (4.5%) experienced transient unilateral vocal cord palsy. Temporary hypocalcemia was observed in eight patients in the TT group (36.4%). No permanent recurrent laryngeal nerve palsy or hypoparathyroidism occurred in either group.
The HS alone in clipless and sutureless endoscopic thyroidectomy provides a good alternative to the conventional ligation or clipping technique because it is associated with a shorter operating time and a relatively low incidence of complications.
超声刀（HS）已被应用于内镜甲状腺切除术，并取得了令人鼓舞的结果。然而，为了完成止血，通常需要额外的器械。本研究旨在评估无附加器械的内镜甲状腺切除术中，使用 HS 进行无夹闭、无缝合技术的安全性和有效性。
共 114 例患者接受经单侧腋窝入路内镜甲状腺半切术（HT）或甲状腺全切除术（TT）。所有病例均仅采用 HS 实现止血。检查围手术期并发症、手术相关结局和病理结局。
TT 组（n=22）的手术时间（170.23±45.63min）长于 HT 组（n=92，111.63±38.44min；p=0.0000）。在前 50 例手术后，手术时间显著缩短（145.60±52.72min 比 105.23±30.14min，p=0.0000）。HT 组有 3 例（3.3%）患者的皮瓣有轻微血肿。HS 用于甲状腺切除术中，未发现甲状腺切除部位有术后出血或血肿。HT 组 4 例（4.3%）和 TT 组 1 例（4.5%）患者出现一过性单侧声带麻痹。TT 组有 8 例（36.4%）患者出现短暂性低钙血症。两组均无永久性喉返神经麻痹或甲状旁腺功能减退。
在无夹闭、无缝合的内镜甲状腺切除术中，单独使用 HS 是传统结扎或夹闭技术的良好替代方法，因为它具有较短的手术时间和相对较低的并发症发生率。
