Harmonic focus in thyroidectomy for substernal goiter

Objectives No previous prospective study has evaluated harmonic scalpel in thyroidectomy for substernal goiter. The objective of this study was to evaluate the use of harmonic scalpel (FOCUS shear, Ethicon Endo-Surgery) in thyroidectomy for substernal goiter for blood loss, operative time, hospital stay and complications. Materials and methods Prospective non-randomised study of 242 consecutive patients with substernal goiter out of 2258 patients (11%) who underwent thyroidectomy. A total of 121 patients had thyroidectomy performed with bipolar electrocoagulation and knot-tying techniques and 121 patients had harmonic scalpel thyroidectomy. Results The use of harmonic scalpel was associated with significant reduction in intraoperative blood loss (50 vs. 100 mL, p = 0.001), postoperative haemorrhage (4% vs. 12%, p = 0.03) and length of hospital stay (2 vs. 3 days, p = 0.001). The mean operative time was significantly longer in the harmonic group. Conclusion Harmonic scalpel is a safe tool for thyroidectomy for substernal goiter. Its utilisation is associated with reduced blood loss, lower incidence of postoperative haemorrhage and shorter hospital stay.