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갑상선 전 절제술과 경부 중앙 림프절 절제술 시 하모닉 포커스(Harmonic Focus) 사용의 안전성과 효용성에 대한 무작위 배정 연구

Total Thyroidectomy with Central Neck Dissection Using Harmonic Focus: A Randomized Clinical Trial

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초록

Purpose: The use of sealing devices such as Harmonic scalpel and Ligasure is increasing steadily in thyroid surgery. The Harmonic Focus (HF) is an ultrasonic device that enables simultaneous vessel sealing and tissue coagulation, designed for open surgery such as thyroidectomy. The aim of this study is to assess the efficiency and safety of HF use in thyroid surgery compared to Conventional Tying (CT).Methods: A prospective study was conducted to compare the efficacy of HF versus CT. We evaluated 50 patients who underwent surgery for thyroid tumor at Korea University Anam Hospital. All patients underwent total thyroidectomy with central neck dissection after being randomly allocated into two groups: HF group and CT group. The differences in surgical outcomes and postoperative complications by device use, i.e. group assignment, were statistically analyzed.Results: There were no differences in number of retrieved lymph nodes (P=0.595), number of resected parathyroid glands (P=0.330), immediate postoperative iPTH (P=0.252), length of hospitalization (P=0.375) between HF group and CT group. However, operative time was shorter in HF group than CT group (106.07±20.92 min vs. 136.54±38.24 min, P=0.046). Postoperative complications of wound infection, seroma, hematoma, chyle leakage, vocal cord palsy, and hypoparathyroidism did not differ between groups.Conclusion: HF is a safe, effective, and time-saving technique; outcomes are comparable with CT. Both intraoperative and postoperative variables were similar between groups. Future larger studies are warranted to further investigate the effect on postoperative complications.

Abstract

Purpose: The use of sealing devices such as Harmonic scalpel and Ligasure is increasing steadily in thyroid surgery. The Harmonic Focus (HF) is an ultrasonic device that enables simultaneous vessel sealing and tissue coagulation, designed for open surgery such as thyroidectomy. The aim of this study is to assess the efficiency and safety of HF use in thyroid surgery compared to Conventional Tying (CT).Methods: A prospective study was conducted to compare the efficacy of HF versus CT. We evaluated 50 patients who underwent surgery for thyroid tumor at Korea University Anam Hospital. All patients underwent total thyroidectomy with central neck dissection after being randomly allocated into two groups: HF group and CT group. The differences in surgical outcomes and postoperative complications by device use, i.e. group assignment, were statistically analyzed.Results: There were no differences in number of retrieved lymph nodes (P=0.595), number of resected parathyroid glands (P=0.330), immediate postoperative iPTH (P=0.252), length of hospitalization (P=0.375) between HF group and CT group. However, operative time was shorter in HF group than CT group (106.07±20.92 min vs. 136.54±38.24 min, P=0.046). Postoperative complications of wound infection, seroma, hematoma, chyle leakage, vocal cord palsy, and hypoparathyroidism did not differ between groups.Conclusion: HF is a safe, effective, and time-saving technique; outcomes are comparable with CT. Both intraoperative and postoperative variables were similar between groups. Future larger studies are warranted to further investigate the effect on postoperative complications.

참고문헌 (11)

  1. Delbridge L, "Total thyroidectomy for bilateral benign multinodular goiter: effect of changing practice", Arch Surg, 134, pp.1389~1393 (1999)
  2. Lang BH, "A review of risk factors and timing for postoperative hematoma after thyroidectomy: is outpatient thyroidectomy really safe?", World J Surg, 36, pp.2497~2502 (2012)
  3. Siperstein AE, "The use of the harmonic scalpel vs conventional knot tying for vessel ligation in thyroid surgery", Arch Surg, 137, pp.137~142 (2002)
  4. Koh YW, "The harmonic scalpel technique without supplementary ligation in total thyroidectomy with central neck dissection: a prospective randomized study", Ann Surg, 247, pp.945~949 (2008)
  5. Sherman JA, "Ultracision: the harmonic scalpel and its possible uses in maxillofacial surgery", Br J Oral Maxillofac Surg, 38, pp.530~532 (2000)
  6. Wolf RK, "Early results of thoracoscopic internal mammary artery harvest using an ultrasonic scalpel", Eur J Cardiothorac Surg, 14(Suppl 1), pp.S54~S57 (1998)
  7. Amaral JF, "Laparoscopic cholecystectomy in 200 consecutive patients using an ultrasonically activated scalpel", Surg Laparosc Endosc, 5, pp.255~262 (1995)
  8. Rothenberg SS, "Laparoscopic splenectomy using the harmonic scalpel", J Laparoendosc Surg, 6(Suppl 1), pp.S61~S63 (1996)
  9. Karvounaris DC, "Efficacy and safety of ultrasonically activated shears in thyroid surgery", Head Neck, 28, pp.1028~1031 (2006)
  10. Shin YS, "The efficacy of the harmonic scalpel in neck dissection: a prospective randomized study", Laryngoscope, 123, pp.904~909 (2013)
  11. Chang LY, "Sutureless total thyroidectomy: a safe and cost-effective alternative", ANZ J Surg, 81, pp.510~514 (2011)

관련 논문AI추천

Usefulness of the Harmonic Scalpel in Thyroid Surgery최환, 권순영, 박민우, 백승국, 우정수, 정광윤대한갑상선학회 · International Journal of Thyroidology2012 · 제5권 제2호A Prospective, Randomized, Controlled Comparative Study of Three Energy Devices in Open Thyroid Surgery: Thunderbeat, Harmonic, and Ligasure백교림, Jee Soo Kim, Jung Han Kim, Jun-Ho Choe, Min Jhi Kim, Nayoon Hur대한내분비외과학회 · Journal of Endocrine Surgery2019 · 제19권 제4호Post-operative Hypocalcaemia Following Open Thyroidectomy for Benign Multinodular Goiters Using FOCUS Harmonic Scalpel Versus Conventional Suture Ligation Technique for Hemostasis: a Prospective, Single-blind, Randomized Controlled TrialSadaf Zehra, Sughra Parveen대한내분비외과학회 · Journal of Endocrine Surgery2018 · 제18권 제2호갑상선 부갑상선 수술에서 합병증 예방을 위한 술기의 발전지용배대한이비인후과학회 · 대한이비인후과학회지 두경부외과학2025 · 제68권 제9호편측 갑상선 절제술시 배액관 유무에 따른 유용성 비교 연구박다희, 성의숙, 이민형, 이재민, 이진춘, 장효범대한이비인후과학회 부산,울산,경남 지부회 · 임상이비인후과2021 · 제32권 제1호Letter to the Editor: A Prospective, Randomized, Controlled Comparative Study of Three Energy Devices in Open Thyroid Surgery: Thunderbeat, Harmonic, and LigasureMayilvaganan Sabaretnam, Vnssvams Mahalakshmi D대한내분비외과학회 · Journal of Endocrine Surgery2020 · 제20권 제1호

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