Comparison of the Harmonic Focus and the Thunderbeat for Open Thyroidectomy

Overview

Journal Langenbecks Arch Surg

Specialty General Surgery

Date 2016 May 26

PMID 27222244

Citations 11

Authors

Sam Van Slycke

Jean-Pierre Gillardin

Klaas Van Den Heede

Joan Minguet

Hubert Vermeersch

Nele Brusselaers

Affiliations

Soon will be listed here.

Abstract

Purpose: An effective method for controlling haemostasis during open thyroidectomy procedures is crucial because of the high risks of haemorrhage and neck haematoma. This study aimed to demonstrate the efficacy of the integrated ultrasonic/bipolar Thunderbeat™ for this procedure.

Methods: This retrospective non-inferiority study compared the Thunderbeat™ and the ultrasonic Harmonic Focus® devices in 761 consecutive patients receiving a partial or total open thyroidectomy (with or without neck dissection). The main outcomes were duration of surgery, blood loss, and length of hospitalisation. Secondary outcomes were occurrence of hypocalcaemia, recurrent nerve paralysis, or other post-operative complications. A non-inferiority logistic regression approach was used to evaluate primary outcomes, adjusting for age, gender, body mass index, type of surgery, anaesthesiology score, and indication (benign or malign).

Results: The data demonstrated that the Thunderbeat was non-inferior to the Focus in terms of duration of surgery, blood loss, and length of hospital stay. Furthermore, subgroup analyses showed non-inferiority of the Thunderbeat for partial thyroidectomy (all three outcomes), total thyroidectomy (duration of surgery and length of hospitalisation), and total thyroidectomy with neck dissection (length of hospitalisation). In terms of recurrent nerve paralysis and post-operative complications, the Thunderbeat performed at least as well as the Focus; however, no conclusions could be drawn regarding the occurrence of post-operative hypocalcaemia.

Conclusion: In a cohort of patients that underwent partial or total thyroidectomy, the Thunderbeat appeared to be at least as good as the Harmonic Focus.

Citing Articles

Techniques for Thyroidectomy and Functional Neck Dissection.

Agcaoglu O, Sucu S, Toprak S, Tezelman S J Clin Med. 2024; 13(7).

PMID: 38610679 PMC: 11012902. DOI: 10.3390/jcm13071914.

Complications associated with energy-based devices during thyroidectomy from 2010-2020.

Lee E, Tong J, Pasick L, Benito D, Joshi A, Thakkar P World J Otorhinolaryngol Head Neck Surg. 2023; 9(1):35-44.

PMID: 37006740 PMC: 10050967. DOI: 10.1016/j.wjorl.2021.04.008.

Electrocautery, Harmonic, and Thunderbeat Instruments in Parotid Surgery: A Retrospective Comparative Study.

Vaira L, Rizzo D, Murrocu C, Zullo C, Dessy M, Mureddu L J Clin Med. 2022; 11(24).

PMID: 36556028 PMC: 9788463. DOI: 10.3390/jcm11247414.

The Use of Harmonic Focus and Thunderbeat Open Fine Jaw in Thyroid Surgery: Experience of a High-Volume Center.

Canu G, Medas F, Cappellacci F, Casti F, Bura R, Erdas E J Clin Med. 2022; 11(11).

PMID: 35683450 PMC: 9181533. DOI: 10.3390/jcm11113062.

Differentiated Thyroid Cancer: A Health Economic Review.

Van Den Heede K, Tolley N, Di Marco A, Palazzo F Cancers (Basel). 2021; 13(9).

PMID: 34067214 PMC: 8125846. DOI: 10.3390/cancers13092253.

References

Pons Y, Gauthier J, Ukkola-Pons E, Clement P, Roguet E, Poncet J . Comparison of LigaSure vessel sealing system, harmonic scalpel, and conventional hemostasis in total thyroidectomy. Otolaryngol Head Neck Surg. 2009; 141(4):496-501. DOI: 10.1016/j.otohns.2009.06.745. View

Touzopoulos P, Karanikas M, Zarogoulidis P, Mitrakas A, Porpodis K, Katsikogiannis N . Current surgical status of thyroid diseases. J Multidiscip Healthc. 2012; 4:441-9. PMC: 3256004. DOI: 10.2147/JMDH.S26349. View

Tredici P, Grosso E, Gibelli B, Massaro M, Arrigoni C, Tradati N . Identification of patients at high risk for hypocalcemia after total thyroidectomy. Acta Otorhinolaryngol Ital. 2011; 31(3):144-8. PMC: 3185817. View

Hefermehl L, Largo R, Hermanns T, Poyet C, Sulser T, Eberli D . Lateral temperature spread of monopolar, bipolar and ultrasonic instruments for robot-assisted laparoscopic surgery. BJU Int. 2013; 114(2):245-52. DOI: 10.1111/bju.12498. View

Dionigi G, Boni L, Rausei S, Frattini F, Ferrari C, Mangano A . The safety of energy-based devices in open thyroidectomy: a prospective, randomised study comparing the LigaSure™ (LF1212) and the Harmonic® FOCUS. Langenbecks Arch Surg. 2012; 397(5):817-23. DOI: 10.1007/s00423-011-0898-0. View

Cates C, Karner C . Clinical importance cannot be ruled out using mean difference alone. BMJ. 2015; 351:h5496. DOI: 10.1136/bmj.h5496. View

Milsom J, Trencheva K, Monette S, Pavoor R, Shukla P, Ma J . Evaluation of the safety, efficacy, and versatility of a new surgical energy device (THUNDERBEAT) in comparison with Harmonic ACE, LigaSure V, and EnSeal devices in a porcine model. J Laparoendosc Adv Surg Tech A. 2012; 22(4):378-86. DOI: 10.1089/lap.2011.0420. View

Duan Y, Xue W, Zhu F, Sun D . FOCUS harmonic scalpel compared to conventional hemostasis in open total thyroidectomy - a prospective randomized study. J Otolaryngol Head Neck Surg. 2013; 42:62. PMC: 3892114. DOI: 10.1186/1916-0216-42-62. View

Campbell P, Cresswell A, Frank T, Cuschieri A . Real-time thermography during energized vessel sealing and dissection. Surg Endosc. 2003; 17(10):1640-5. DOI: 10.1007/s00464-002-8781-2. View

10.

Lyons S, Law K . Laparoscopic vessel sealing technologies. J Minim Invasive Gynecol. 2013; 20(3):301-7. DOI: 10.1016/j.jmig.2013.02.012. View

11.

Contin P, Goossen K, Grummich K, Jensen K, Schmitz-Winnenthal H, Buchler M . ENERgized vessel sealing systems versus CONventional hemostasis techniques in thyroid surgery--the ENERCON systematic review and network meta-analysis. Langenbecks Arch Surg. 2013; 398(8):1039-56. DOI: 10.1007/s00423-013-1137-7. View

12.

Mascha E, Sessler D . Equivalence and noninferiority testing in regression models and repeated-measures designs. Anesth Analg. 2011; 112(3):678-87. DOI: 10.1213/ANE.0b013e318206f872. View

13.

Tamayo-Sarver J, Albert J, Tamayo-Sarver M, Cydulka R . Advanced statistics: how to determine whether your intervention is different, at least as effective as, or equivalent: a basic introduction. Acad Emerg Med. 2005; 12(6):536-42. DOI: 10.1197/j.aem.2005.01.010. View

14.

Nair C, J C Babu M, Menon R, Jacob P . Hypocalcaemia following total thyroidectomy: An analysis of 806 patients. Indian J Endocrinol Metab. 2013; 17(2):298-303. PMC: 3683209. DOI: 10.4103/2230-8210.109718. View

15.

Emam T, Cuschieri A . How safe is high-power ultrasonic dissection?. Ann Surg. 2003; 237(2):186-91. PMC: 1522135. DOI: 10.1097/01.SLA.0000048454.11276.62. View

16.

Rahbari R, Mathur A, Kitano M, Guerrero M, Shen W, Duh Q . Prospective randomized trial of ligasure versus harmonic hemostasis technique in thyroidectomy. Ann Surg Oncol. 2010; 18(4):1023-7. DOI: 10.1245/s10434-010-1251-5. View

17.

Bliss R, Gauger P, Delbridge L . Surgeon's approach to the thyroid gland: surgical anatomy and the importance of technique. World J Surg. 2000; 24(8):891-7. DOI: 10.1007/s002680010173. View

18.

Dhepnorrarat R, Witterick I . New technologies in thyroid cancer surgery. Oral Oncol. 2013; 49(7):659-64. DOI: 10.1016/j.oraloncology.2013.03.445. View

19.

Van Slycke S, Gillardin J, Brusselaers N, Vermeersch H . Initial experience with S-shaped electrode for continuous vagal nerve stimulation in thyroid surgery. Langenbecks Arch Surg. 2013; 398(5):717-22. DOI: 10.1007/s00423-013-1068-3. View

20.

Gossot D, Buess G, Cuschieri A, Leporte E, Lirici M, Marvik R . Ultrasonic dissection for endoscopic surgery. The E.A.E.S. Technology Group. Surg Endosc. 1999; 13(4):412-7. DOI: 10.1007/s004649901002. View