Does the ultrasound dissector improve parathyroid gland preservation during surgery? M.R. Pelizzo a , N. Sorgato a , I. Isabella Merante Boschin a , M.C. Marzola b , P.M. Colletti c , D. Rubello b, * a Surgical Pathology, Department of Medical and Surgical Sciences, University of Padova, Padova, Italy b Department of Radiology, University of Southern California, Los Angeles, CA, USA c Department of Nuclear Medicine, Santa Maria della Misericordia Hospital, Rovigo, Italy Accepted 10 March 2014 Available online 3 April 2014 Abstract Background: The most common complication of thyroid surgery is hypoparathyroidism, usually temporary. Ischemic injury or parathyroid avulsion are the causes of surgical hypoparathyroidism. We assessed the value of an ultrasound scalpel, the Harmonic Focus Ò (HF), could prevent surgical-related hypoparathyroidism. Methods: Patients consecutively undergoing total thyroidectomy using the HF from November 2009 to February 2011 were recruited and their clinical characteristics, type of operation, histology, and postoperative calcium levels (normal range: 2.10e2.55 mMol/l) were re- corded. The prevalence of transient and permanent hypocalcemia was calculated for benign vs. malignant diseases and compared with a control group of 147 patients treated surgically in 2005 using manual technique. Results: 139 patients treated by the same surgeon with a total thyroidectomy (41.7% for a malignant disease) were considered. Prevalence of transient hypoparathyroidism (THP) was 45.2% and of definitive hypoparathyroidism (DHP) 1.4%. None of the patients with malig- nancies were hypocalcemic at 1-year follow-up. In the control group THP was found in 51.7% of cases and DHP in 5.4% ( p < 0.001). Conclusions: Use of the ultrasound scalpel improved the likelihood of the parathyroid glands preservation during thyroid surgery. Paradox- ically, the HF appears to be more effective in treating malignant disease, i.e. when central node dissection is required. Ó 2014 Elsevier Ltd. All rights reserved. Keywords: Thyroidectomy; Parathyroid gland preservation; Ultrasound dissector Introduction When the technical approaches for total thyroidectomy were first established, at the end of the 1800s, 1 it was already clear that failure of preservation of the parathy- roid glands was commonly associated with tetanic paraly- sis. In the absence of treatment options, tetanic paralysis was a major cause of postoperative death, along with cachexia strumipriva and hemorrhage. Theodor Billroth developed a method for subtotal as opposed to total thy- roidectomy with a view to reducing such complications, but this carried the risk of numerous recurrences and difficult reoperations. Once the parathyroids had been identified and described in terms of their morphology and function, and replacement therapies had been intro- duced (the credit for having first described a parathyroid in 1852, during an autopsy on a rhinoceros at London zoo, goes to Sir Richard Owen, 2 while Ivar Sandstrom, a Swedish student at Uppsala university was the first to describe a parathyroid in humans in 1880 3 ), numerous au- thors suggested methods and tactics for parathyroid pres- ervation. Hypoparathyroidism nonetheless remains the most common complication of thyroid surgery, with an incidence that varies considerably in the literature, with cases of transient hypoparathyroidism (THP) reportedly affecting from 1.6% to 83% of cases, due mainly to differ- ences in the clinical or biochemical assessment criteria adopted, and calcemia parameters considered, as well as to the specific experience of the surgeons involved. 4 * Corresponding author. PET/CT Centre, Santa Maria della Misericordia Hospital, Rovigo, Italy. E-mail addresses: domenico.rubello@libero.it, rubello.domenico@ azisanrovigo.it (D. Rubello). 0748-7983/$ - see front matter Ó 2014 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ejso.2014.03.007 Available online at www.sciencedirect.com ScienceDirect EJSO 40 (2014) 865e868 www.ejso.com