Volume 1 • Issue 4 • 1000117 Thyroid Disorders Ther ISSN: 2167-7948 JTDT, an open access journal Open Access Yetisir et al., Thyroid Disorders Ther 2012, 1:4 DOI: 10.4172/2167-7948.1000117 Open Access Research Article The Impact of Harmonic Scalpel on Complications after Neck Dissection in Papillary Thyroid Carcinoma: A Prospective Randomized Study Fahri Yetişir 1 *, Banu Yürekli 2 , A Ebru Salman 3 , Mustafa Ünal 4 , Hasan Zafer Acar 5 , Murat B Yildirim 1 and Mehmet Kilic 6 1 Ankara Atatürk Research and Trainning Hospital, General Surgery Department, Turkey 2 Bozyaka Research and Trainning Hospital, Endocrinology, Turkey 3 Ankara Atatürk Research and Training Hospital, Anesthesiology and Reanimation Department, Turkey 4 Etlik Research and Training Hospital, Endocrinology, Turkey 5 Yozgat Bozok University, General Surgery, Turkey 6 Yildirim Beyazit University, General Surgery Department, Turkey *Corresponding author: Dr. Fahri Yetişir, Etlik Research and Training Hospital General Surgery, Turkey, Tel: +90 536 297 48 88; E-mail: drfahriyetisir@hotmail.com Received October 17, 2012; Accepted October 27, 2012; Published October 29, 2012 Citation: Yetişir F, Yürekli B, Salman , Ünal M, Acar HZ, et al. (2012) The Impact of Harmonic Scalpel on Complications after Neck Dissection in Papillary Thyroid Carcinoma: A Prospectıve Randomized Study. Thyroid Disorders Ther 1:117. doi:10.4172/2167-7948.1000117 Copyright: © 2012 Yetişir F, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Keywords: Harmonic scalpel; Neck dissection; Papillary thyroid carcinoma Introductıon Surgical principles established by the pioneers of thyroid, were good exposure of thyroid gland, clear identifcation of nerves, parathyroid glands and perfect heamostasis [1]. New vessel sealing technologies Ligasure (Covidien, Boulder, Colorado) and Harmonic Scalpel (Ethicon Endo-Surgery Inc, Cincinnati, Ohio) have emerged in the recent literature [2-4]. Harmonic Scalpel (HS) is a new promising tool introduced to surgery two decades ago. It uses high frequency (55,500 Hz) mechanical energy to cut and coagulate tissues at the same time. Mechanism of HS depends on denaturation of protein by using ultrasonic vibration to transfer mechanical energy sufcient to break tertiary hyrogen bonds [5,6]. Proposed advantages with its use include less thermal tissue damage to adjacent structures as compared with electrocautery and reduction in the operative time due to combination of simultaneous cutting and coagulation functions [7]. Tere have been several recent studies investigating the safety of HS in patients undergoing thyroidectomy [8-10]. Most studies conclude that use of HS decreases both operative time and intraoperative blood loss and provides benefts in postoperative pain without increasing complication rates when compared to conventional techniques [7-11]. Te aim of this prospective randomized study is to evaluate the efect of HS on complications in dissection of lef lower neck region and parathyroid glands and nerves (recurrent inferior laryngeal nerve, vagus, accessory, phrenic and hypoglossal) in patients with papillary thyroid carcinoma (PTC) undergoing central or lateral neck dissection. Abstract Aım: The aim of this study was to investigate whether Harmonic Scalpel (HS) increases the complication rate in the patients undergoing neck dissection in patients with Papillary Thyroid Carcinoma (PTC). Methods: 95 patients with PTC undergoing bilateral total thyroidectomy and central or lateral neck dissection were included in to study. Patients whom heamostasis was carried out using HS at each stage of the operation were classifed as group I (n=52), and patients whom heamostasis was performed without HS in the dissection of nerves and in the dissection of regions containing parathyroids and ductus thoracicus as Group II (n=43). Groups were compared in terms of operation time, postoperative nerve injury, hypoparathyroidsm and development of chylous fstula. Results: Demographic data, stage of tumor and type of operation were similar between groups. Mean operation time was 19 min. shorter in group I (p=0.003). There was no difference in nerve injury and hypoparathyroidsm between groups. Chylous fstula was seen in 3(5.7%) patients in group I. It was not seen in group II. Conclusıon: Use of HS in patients with PTC undergoing neck dissection decreases operation time signifcantly without increasing the rate of nerve and parathyroid injury, but may increase the risk of development of chylous fstula. Material and Method Afer approval was obtained fom local ethical committee, informed consent was taken from 104 patients undergoing operation for stage II-IVa PTC. Of these, 6 patients using warfarin. 1 patient who has RILN injury due to a previous operation and 2 patients with hypoparathyroidism were excluded from the study (Figure 1). Of 95 patients included in the study, 71 underwent bilateral total thyroidectomy (BTT) and central neck dissection (CND) and 24 underwent BTT and lateral functional neck dissection (LND). All operations were performed by the same surgical team. Te surgeon was blinded to the technique to which the patients were assigned upon opening the envelopes in the operating room, just before surgery. Patients in whom heamostasis was carried out using HS at each stage of the operation were classifed as group I (n=52), and patients in whom heamostasis was performed without HS in the dissection of nerves (recurrent laryngeal nerve, vagus, accessory, phrenic and hypoglossal nerve) and in the dissection of regions containing parathyroids and Journal of Thyroid Disorders & Therapy J o u r n a l o f T h y r o i d D i s o r d e r s & T h e r a p y ISSN: 2167-7948