Complications in thyroid surgery. Harmonic Scalpel, Harmonic Focus versus Conventional Hemostasis: A meta-analysis

BackgroundTo evaluate the incidence of postoperative complications, hemostatic effects and safety of Total Thyroidectomy (TT) performed using the Harmonic Scalpel (HS), the Harmonic Focus (HF) or Conventional Hemostasis (CH).MethodsThe meta-analysis was performed according to PRISMA guidelines. A literature search was conducted from 2003 to 2014 and stringent criteria were required for inclusion. Thirteen studies concerning an overall population of 1458 compared HS versus CH, whilst 8 studies with 1667 patients compared HF versus CH.ResultsThere was a significant reduction of operative time (Mean Difference [MD] = −25.49 min.; 95% CI −32.43 to −18.55), intraoperative blood loss (MD = −30.49 mL; 95% CI −53.01 to −7.97), postoperative drainage volume (MD = −12.90 mL; 95% CI −22.83 to −2.98) and postoperative pain (MD = −0.87; 95% CI −1.27 to −0.46) in patients underwent TT with HS.Regarding HF group, a significant reduction of operative time (MD = −25.99 min., 95% CI −34.56 to −17.41), length of hospital stay (MD = −0.57; 95% CI −0.97 to −0.17), transient hypocalcemia (OR = 0.56; 95% CI 0.39 to 0.81) and postoperative pain (MD = −1.33 days; 95% CI −2.49 to −0.17) resulted.ConclusionsHS TT can be a safe, useful and fast alternative to conventional TT. The newer HF can reduce the rate of hypocalcemia. Future RCTs of larger patient cohorts with more detailed data of postoperative complications, cost-effectiveness and cosmetic results, randomization procedures, intention-to-treat analyses and blinding of outcome assessors are needed to draw more meaningful conclusions.