The use of harmonic scalpel in thyroid surgery in a tertiary hospital, south-south, Nigeria – early outcomes assessment

Abstract

Context: The advent of surgical energy devices has brought innovations with their use in thyroid surgeries. Despite the widespread use of Harmonic scalpel for decades since its inception in developed countries, there is a paucity of its use in low-resource countries. This report represents our early experience with Harmonic scalpel thyroidectomy in a low-resource setting.
Subjects and Methods: A 16-month audit (June 2018 – September 2019) of thyroid surgeries in a tertiary/referral health facility in South-south, Nigeria was carried out. Eleven patients underwent harmonic scalpel thyroidectomy, however, only 10 patients had complete records and were included in the study. Relevant data including age, sex, pre-operative diagnosis, type of surgery, duration of surgery, blood loss, complication and duration of hospital stay were analyzed using IBM corporation Statistical Package for the Social Sciences (SPSS) statistics for windows, version 21.0. Armonk, New York, United States of America.
Results: Median age was 36 years, 9 were female, most had non-toxic multinodular goitre (40%). Procedures include lobectomy/isthmusectomy (40%), subtotal thyroidectomy, near-total thyroidectomy, total thyroidectomy (20% each. Mean duration of surgery was 83.5±23.1mins. Mean Estimated Blood Loss was 145.0±76.2mls while 90% had mild pain. Weight of thyroid gland ranged from 99 – 420g with a median weight of 300g. Mean duration of hospital stay was 3.1±0.99 days. Transient voice change was noted in 10% of patients. These values were significantly lower than those obtained for conventional thyroidectomy during the period (one-sample t-test, p<0.001).
Conclusion: Our early experience with the harmonic scalpel in thyroidectomy has shown the device to be versatile, easy to use, safe and effective with a significant reduction in blood loss, duration of surgery, postoperative complication and improved recovery time.