Harmonic scalpel thyroidectomy versus conventional haemostasis thyroidectomy

Background: As there is paucity of data on harmonic scalpel thyroidectomy from Jammu and Kashmir belt. So, we conducted this study to bridge this gap and also to create awareness about the use of harmonic scalpel. Thyroidectomy has become one of the most common and frequent surgery. Hemostasis in thyroid surgery is of utmost importance for a successful surgery. Our aim was to compare operative factors, postoperative outcomes of thyroidectomy using the Harmonic Scalpel (HS) and Conventional Haemostasis (CH).Methods: In this randomized control trial study, 100 patients who underwent thyroidectomy were enrolled and randomly divided in two groups- HS group and CH group. The inclusion criteria were age>18years, acceptance to participate in the study (signed informed consent form) and scheduled total thyroidectomy. The groups were compared with regards to age, gender, operative time, post-operative drainage volume, postoperative pain, and hospital stay.Results: The mean age in years was 39.8 years for HS group and 43.8 years for CH group with female preponderance. There was a significant difference with regards to operative time, post-operative drainage volume, postoperative pain, and hospital stay (p<0.001). Harmonic Scalpel shortens the operative time. And there was less post-operative drainage volume and postoperative pain in HS group. Hospital stay was also less as compared to CH group.Conclusions: HS is superior then CH thyroidectomy and is considered as a safe and better tool in thyroidectomy.

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Focus Harmonic Scalpel Compared to Conventional Haemostasis in Open Total Thyroidectomy: A Prospective Randomized Trial

International Journal of Otolaryngology ◽

10.1155/2011/357195 ◽

2011 ◽

Vol 2011 ◽

pp. 1-7 ◽

Cited By ~ 29

Author(s):

Emanuele Ferri ◽

Enrico Armato ◽

Giacomo Spinato ◽

Roberto Spinato

Keyword(s):

Postoperative Pain ◽

Hospital Stay ◽

Randomized Trial ◽

Total Thyroidectomy ◽

Operative Time ◽

Harmonic Scalpel ◽

Thyroid Volume ◽

Prospective Randomized Trial ◽

Drainage Volume ◽

Significant Difference

The aim of this prospective randomized trial was to compare operative factors, postoperative outcomes and surgical complications of open total thyroidectomy when using the Harmonic Scalpel (HS) versus Conventional Haemostasis (CH).Methods. 100 consecutive patients underwent open total thyroidectomy were randomized into two groups: group CH (Conventional Haemostasis) and group HS (Harmonic Scalpel). We recorded the following: age, sex, pathology, thyroid volume, haemostatic technique, operative time, drainage volume, thyroid weight, postoperative pain, postoperative complications, and hospital stay. The results were analyzed using the Student’sttest and test.Results. No significant difference was found between the two groups concerning mean thyroid weight and mean hospital stay. The mean operative time was significantly shorter in the HS group. The total drainage fluid volume was lower in HS group. Two (4%) transient recurrent laryngeal nerve palsies were observed in CH group and no one (0%) in the HS group. Postoperative transient hypocalcemia occurred more frequently in the CH group. HS group experienced significantly less postoperative pain at 24 and 48 hours.Conclusions. In patients undergoing thyroidectomy, HS is a reliable and safe tool. Comparing with CH techniques, its use reduces operative times, postoperative pain, drainage volume and transient hypocalcemia.

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Comparison of Harmonic Scalpel versus conventional hemostasis in Thyroid surgery in terms of per-operative and postoperative outcome.

The Professional Medical Journal ◽

10.29309/tpmj/2019.27.01.3278 ◽

2020 ◽

Vol 27 (01) ◽

pp. 68-73

Author(s):

Mumtaz Ali ◽

Mudassar Murtaza ◽

Mohammad Aleem-ud-Din ◽

Mohammad Burhan Ud Din ◽

Assam Sarwar ◽

...

Keyword(s):

Postoperative Pain ◽

Thyroid Surgery ◽

Operative Time ◽

Harmonic Scalpel ◽

Laryngeal Nerve ◽

P Value ◽

Drainage Volume ◽

Group A ◽

The Mean ◽

Group B

Harmonic scalpel is popular for use in a variety of surgical procedures including thyroid surgery. Proposed advantages of the harmonic scalpel include less lateral thermal tissue damage with no electrical energy transferred to the patient, no neuromuscular stimulation, less smoke formation as compared with electrocautery. Objectives: Our aim was to compare outcomes following thyroid surgery in terms of operative time, postoperative pain, drainage volume, recurrent laryngeal nerve and parathyroid gland injury with the use of the Harmonic Scalpel compared to conventional methods of hemostasis. Study Design: Randomized control trial. Setting: Surgical Department Lahore General Hospital. Period: Twelve Months June 2016 to June 2017. Material & Methods: 60 patients, 30 in each group. Patients were randomized in each group by balloting method. Operative time, postoperative pain and drainage volume was assessed during hospital stay. Recurrent laryngeal nerve and parathyroid gland injury was assessed during hospital stay and follow-up. Results: There was no significant difference in development of hoarseness of voice in both groups, p-value > 0.05. The mean operative time for group A was 69.47 ± 15.44 minutes and for group B it was 54.93 ± 11.56 minutes, p-value <0.05. The overall blood loss in group-A and group-B was 118.73 ± 50.72 ml and 44.60±10.70 ml, p-value<0.05. The mean post-op pain observed at 2nd day for group B was 2.93 ±3.57 and for group A it was 3.57±0.77, p-value < 0.05. Conclusion: Use of Harmonic Scalpel has better results in thyroid surgery in terms of less operative time, less postoperative pain, less drainage volume, while no RLN & parathyroid injury detected in either group.

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Merits of harmonic scalpel over conventional hemostasis in open thyroid surgery: a randomised controlled trial

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20195712 ◽

2019 ◽

Vol 6 (1) ◽

pp. 186

Author(s):

Anushree Bajaj ◽

Bhalchandra Paike ◽

Shahnaz Sheikh ◽

Vikrant Vaze

Keyword(s):

Hospital Stay ◽

Thyroid Surgery ◽

Operative Time ◽

Harmonic Scalpel ◽

Controlled Trial ◽

Thyroid Volume ◽

Drainage Fluid ◽

Drainage Volume ◽

Post Operative Pain ◽

Significant Difference

Background: The pioneers of thyroid surgery, Theodor Kocher and Theodor Billroth, developed an acceptable technique of standardized thyroid surgery between 1873 and 1883. The aim of this prospective randomized trial was to evaluate the efficacy and safety of harmonic scalpel use compared with conventional haemostasis in open thyroid surgery.Methods: A total of 60 consecutive patients underwent open total thyroidectomy were randomized into two groups. Group A with harmonic scalpel and Group B with electrocautery with 30 patients each. Factors including age, sex, pathology, thyroid volume, haemostatic technique, operative time, drainage volume, thyroid weight, postoperative pain, postoperative complications and hospital stay. The results were analysed using the students t-test and x2.Results: No significant difference was found between the two groups concerning mean thyroid weight and mean hospital stay. The mean operative time was shorter in the harmonic scalpel group. The total fluid drainage fluid volume was lower in Harmonic scalpel group shorter in. Harmonic scalpel group experienced significantly less post-operative pain at 24 and 48 hours.Conclusions: In patients undergoing thyroidectomy, harmonic scalpel is a reliable and safe tool. AS compared with conventional haemostasis techniques, its use reduces operative times, post-operative pain, drainage volume and transient hypocalcemia.

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Outcomes of Retrograde Intra-Renal Surgery

Nepalese Medical Journal ◽

10.3126/nmj.v2i2.26478 ◽

2019 ◽

Vol 2 (2) ◽

pp. 220-223 ◽

Cited By ~ 1

Author(s):

Samir Shrestha ◽

Pukar Maskey

Keyword(s):

Postoperative Pain ◽

Hospital Stay ◽

Renal Stone ◽

Operative Time ◽

Renal Calculi ◽

Renal Surgery ◽

Surgical Morbidity ◽

Retrograde Intrarenal Surgery ◽

Stone Clearance ◽

The Mean

Introduction: Miniaturization of endoscopic instruments has gained wide popularity in the treatment of renal calculi. Retrograde intra-renal surgery and holmium laser in combination has already proven its superiority when compared to other modalities in the treatment of renal calculi. This study was conducted to assess the outcome of retrograde intra-renal surgery in renal stone disease.Materials and Methods: This retrospective study analyzed the outcome of retrograde intra-renal surgery in renal stone less than 2 cm size in the adults above 18 years of age from September 2018 to August 2019 at Patan Hospital, Nepal. The outcome was assessed descriptively on postoperative pain and fever, stone localization, stone size, stone clearance, urosepsis, operative time, hospital stay, mortality, need of the second procedure.Results: A total of 62 patients underwent retrograde intrarenal surgery, out of which 48 cases were included. The mean age of the study population was 32.4± 14 years (19-68 years). Similarly, the mean operative time was 68± 12 (48-124 minutes) and mean hospital-stay was 3.2± 1.1 days. Postoperative pain and fever were observed in 14 (29.16%) & 4(8.33%) patients respectively. Hematuria occurred in 6(12.50%) and urosepsis in 2(4.16%) of the patients. Complete stone clearance was achieved in 34(70.83%) and residual stones were present in 8(16.66%) and clinically insignificant radiological fragments were present in 6(12.50%) patients.Conclusions: Retrograde intrarenal surgery is a technically safe and effective procedure for the treatment of renal calculi, with minimal post-surgical morbidity.

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Laparoscopic cholecystectomy in Jordan

Eastern Mediterranean Health Journal ◽

10.26719/2001.7.4-5.838 ◽

2001 ◽

Vol 7 (4-5) ◽

pp. 838-840

Author(s):

A. Al Raymoony

Keyword(s):

Laparoscopic Cholecystectomy ◽

Postoperative Pain ◽

Return To Work ◽

Hospital Stay ◽

Operative Time ◽

Safe Procedure ◽

Short Hospital Stay ◽

Early Return ◽

The Mean ◽

Mean Time

This study was conducted on 100 patients with symptomatic gallbladder stones, aged 22-81 years with a mean of 51.5 years, who underwent cholecystectomy in Zarqa city, Jordan between July 1998 and July 1999. The success rate was 87% and the procedure was completed using the conventional method in 13 patients. The mean operative time was 60 minutes, complication rate was 5% and there were no deaths. The mean hospital stay was 1 day and mean time to return to work was 10 days. This study showed that laparoscopic cholecystectomy is a safe procedure with reasonable operative time, less postoperative pain, a short hospital stay, early return to work, and a low morbidity and mortality rate.

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The Safety and Efficacy of Cervical Laminectomy and Fusion versus Cervical Laminoplasty Surgery in Degenerative Cervical Myelopathy: A Prospective Randomized Trial

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2020.4841 ◽

2020 ◽

Vol 8 (B) ◽

pp. 807-814

Author(s):

Mohamed Elmallawany ◽

Haitham Kandel ◽

Mohamed A. R. Soliman ◽

Tarek Ahmed Tareef ◽

Ahmed Atallah ◽

...

Keyword(s):

Hospital Stay ◽

Randomized Trial ◽

Operative Time ◽

Prospective Randomized Trial ◽

Cervical Laminectomy ◽

Significant Difference ◽

Operative Complications ◽

Cobb’S Angle ◽

The Mean ◽

Degenerative Cervical Myelopathy

BACKGROUND: There is a lack of evidence of whether degenerative cervical myelopathy (DCM) is best treated through cervical laminoplasty (CLP) or cervical laminectomy with lateral mass fusion due to the lack of prospective randomized studies that are well designed. We conducted the largest prospective randomized trial to date to determine the comparative effectiveness and safety of both approaches. METHODS: In this prospective, randomized trial, we randomly assigned patients who had symptoms or signs of DCM to undergo either cervical laminectomy and lateral mass fixation (CLF) or CLP. The primary outcome measures were the change in the Visual Analog Scale (VAS), neck disability index, modified Japanese Orthopedic Association (mJOA) score, and Nurick’s myelopathy grading 1 year after surgery. The secondary outcome measures were the intraoperative, post-operative complications, hospital stay, C2-7 Cobb’s angle, and Odom’s criteria. The follow-up period was at least 1 year. RESULTS: A total of 30 patients (mean age, 54.5 ± 5.5 years, 70% of men) underwent prospective randomization. There was a significantly greater improvement in neck pain (VAS) in the CLF group at 1 year (p < 0.05). The improvement in the mJOA and Nurick’s myelopathy grading showed insignificant improvement between both groups. Furthermore, there was no significant difference in the patient’s post-operative satisfaction (Odom’s criteria). The mean operative time was significantly longer in the CLF group (p < 0.001), with no significant difference in the post-operative complications, however, there was a higher rate of C5 palsy, dural tear and infection in the CLF, and a higher rate of instrumentation failure in the CLP. The mean hospital stay was significantly longer in the posterior group (p < 0.05). Finally, there was a significant better improvement in the C2-7 Cobb’s angle at 1 year in the CLF group (p < 0.05). CONCLUSION: Among patients with multilevel DCM, the CLF approach was significantly better regarding the post-operative pain and Cobb’s angle while the CLP was significantly better in terms of shorter hospital stay and operative time.

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Initial Clinical Outcomes of Percutaneous FullEndoscopic Lumbar Discectomy Using an Interlaminar Approach at the L4-L5

January 2018 - Pain Physician ◽

10.36076/ppj.2017.e512 ◽

2017 ◽

Vol 4 (20;4) ◽

pp. E507-E512 ◽

Cited By ~ 4

Author(s):

Jun-ichiro Nakamura

Keyword(s):

Hospital Stay ◽

Clinical Outcomes ◽

Disc Herniation ◽

Operative Time ◽

Small Sample ◽

Lumbar Discectomy ◽

Interlaminar Approach ◽

Significant Difference ◽

Endoscopic Discectomy ◽

The Mean

Background: Percutaneous full-endoscopic discectomy (PED) is being increasingly used because of its potential to minimalize soft-tissue damage and decrease hospital stay. PED using the interlaminar approach (PED-IL) at L4-L5 is performed by only a few surgeons. To the best of our knowledge, the safety and efficacy of PED-IL at L4-L5, without experience in PED via a transforaminal approach (PED-TF) has not been previously reported. Objective: This study aimed to evaluate initial clinical outcomes and complications of PED-IL at L4-L5 without experience in PED-TF. Study Design: Retrospective evaluation. Setting: An urban minimally invasive spine hospital. Methods: Of a total of 50 patients (36 men and 14 women, ages ranging from 21-59 years, with the average age being 40.3 years old), 16 cases were performed at L4-L5 and 34 cases were performed at L5-S1. PED-IL was successfully completed in all cases, and no case required conversion to open surgery. The operative time, hospital stay, modified MacNab criteria, and visual analog scale (VAS) scores were examined at L5-S1 (range: 41-112). There was no significant difference in operative time between the L4-L5 and L5-S1 groups; the operative time was gradually decreased. The mean hospital stay was 2.9 days (range: 2-8 days). According to modified MacNab criteria, 20 cases (6 at L4-L5 and 14 at L5-S1) were excellent, 27 (10 at L4-L5 and 17 at L5-S1) were good, one at L5-S1 was fair, and 2 at L5-S1 were poor. Two perineurium tears occurred at L5-S1. There was no infection or recurrence of herniated nucleus pulposus (HNP). The clinical outcomes of PED-IL at L4-L5 were equal to those at L5- S1. Results: The mean operative time was 71.3 ± 19.3 minutes for all cases (range: 41-112 mins.),76.1 ± 16.8 minutes at L4-L5 (range: 52-102 mins.), and 70.5 ± 20.1 minutes at L5-S1 (range: 41-112 mins.). Limitations: A small sample size and a short follow-up period. Conclusions: The clinical outcomes of PED-IL at L4-L5 were equal to those at L5-S1. Therefore, PED-IL is suitable to be a standard method for any type of intracanalicular disc herniation. Keywords: Percutaneous full-endoscopic lumbar discectomy, interlaminar approach, clinical outcome, herniated nucleus pulpous, MacNab criteria, intracanalicular disc herniation, learning curve

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Laparoscopic Dismembered Pyeloplasty for Ureteropelvic Junction Obstruction: Our Preliminary Experience

Bangladesh Journal of Urology ◽

10.3329/bju.v19i2.49364 ◽

2020 ◽

Vol 19 (2) ◽

pp. 59-63

Author(s):

Md Mahfuzur Rahman Chowdhury ◽

AKM Khurshidul Alam ◽

AKM Anwarul Islam ◽

Md Sajid Hasan ◽

Tms Hossain ◽

...

Keyword(s):

Renal Function ◽

Postoperative Pain ◽

Hospital Stay ◽

Operative Time ◽

Ureteropelvic Junction Obstruction ◽

Clinical Symptoms ◽

Ureteropelvic Junction ◽

Laparoscopic Pyeloplasty ◽

The Mean ◽

Urine Leakage

Objective: To evaluate prospectively the results obtained in 16 patients undergoing laparoscopic pyeloplasty through transperitoneal access. Materials and Methods: The study was conducted in the department of urology, BSMMU, Dhaka between the periods of March 2013 and June 2014, sixteen patients between 15 and 48 years old, were treated for ureteropelvic junction obstruction (UPJO) via a transperitoneal laparoscopy. All patients had clinical symptoms of urinary obstruction and hydronephrosis were confirmed by imaging methods. Anderson-Hynes dismembered pyeloplasty was performed in all patients. Patients were clinically and imaging evaluated in the postoperative period at 6 and 12 weeks. Results: Most of the patients were male (68.75%) and female were 31.25%. The mean operative time was 127.37 (±15.67) minutes ranged from 95 to 240 minutes. Pain score in first postoperative day and third postoperative day following pyeloplasty were 20.87 (±6.83) and 4.75 (±3.34) respectively. The mean hospital stay was 4.25 (±1.34) days. Anomalous vessels were identified in 4 patients, intrinsic stenosis in 12 patients. Postoperative urine leakage and UTI were seen 18.75%, 12.50% subject respectively. Split renal function and GFR were significantly improved (p<0.05) and improvement of renal functional outcome was 87.50%. Conclusion: Laparoscopic pyeloplasty had the advantages like less postoperative pain and shorter hospital stay. Bangladesh Journal of Urology, Vol. 19, No. 2, July 2016 p.59-63

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Uniportal Videothoracoscopic Surgery: Our Indications and Limits

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000199 ◽

2015 ◽

Vol 10 (5) ◽

pp. 309-313 ◽

Cited By ~ 3

Author(s):

Alessandro Gonfiotti ◽

Massimo Osvaldo Jaus ◽

Daniel Barale ◽

Domenico Viggiano ◽

Natalia Battisti ◽

...

Keyword(s):

Postoperative Pain ◽

Hospital Stay ◽

Pain Score ◽

Chest Wall ◽

Pulmonary Nodule ◽

Operative Time ◽

Chest Wall Tumor ◽

Wide Range ◽

The Mean ◽

Videothoracoscopic Surgery

Objective We present our experience with uniportal videothoracoscopic surgery (VATS-U), examining its indications, limits, and results. Methods Since January 2009, 66 patients underwent VATS-U for the following indications: pneumothorax (n = 25), lung nodule (n = 15; n = 10 with preoperative radiolocalization), wedge biopsy (n = 15), hyperhidrosis (n = 10), and chest wall schwannoma (n = 1). The conversion rate to conventional video-assisted thoracic surgery (VATS), postoperative pain, complications, residual paraesthesia, and hospitalization were analyzed. Operative time, postoperative pain, and paraesthesia were retrospectively compared with a cohort of 172 cases of conventional multiportal VATS, performed in the same period. Results Conversion to traditional VATS was necessary in two cases (pulmonary nodule, n = 1; pneumothorax, n = 1). The mean pain score was 0.8, the mean operation time was 42 minutes, and 10 patients had postoperative paraesthesia that lasted a mean of 7 days. No postoperative complications were reported, and the mean postoperative hospital stay was 3 days (range, 1–6 days). The comparison between the VATS-U and the standard multiportal VATS group showed in the VATS-U group a lower but not statistically significant pain score and paraesthesia as well as a lower and statistically significant operative time. Conclusions Uniportal videothoracoscopic surgery has a wide range of indications: lung apex resections and pleurodesis for spontaneous pneumothorax treatment; pulmonary nodule assessment with or without preoperative localization; lung biopsy for interstitial diseases; unilateral or bilateral sympathectomy to treat hyperhidrosis; benign chest wall tumor evaluation. The limits of this technique are linked to pleural adhesions or lung nodules in difficult positions. In our experience, VATS-U results in minimal postoperative pain, allowing for fast functional recovery and a consequent short hospital stay; thus, we suggest that VATS-U is a valid alternative to traditional multiportal VATS for indications beyond cosmetic benefits. Prospective randomized trials are necessary to validate the advantages of uniportal VATS.

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A Single Surgeon’s Experience of Total Extra Peritoneal Repair Vs Transabdominal Preperitoneal Repair- A Prospective Cohort Study

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2020/47056.14406 ◽

2021 ◽

Author(s):

Tharun Ganapathy Chitrambalam ◽

Koshy Mathew Panicker ◽

Jeyakumar Sundaraj ◽

Sidhu Rajasekhar ◽

Pradeep Joshua Christopher

Keyword(s):

Inguinal Hernia ◽

Postoperative Pain ◽

Hospital Stay ◽

Pain Score ◽

Operative Time ◽

P Value ◽

Tep Repair ◽

Duration Of Hospital Stay ◽

Tapp Repair ◽

The Mean

Introduction: Hernia surgery has evolved over a period of 2500 years from the Bassini-Shouldice era to conventional Lichenstein’s meshplasty to the laparoscopic era. Since, inception of the laparoscopic approach 25 years ago, there were several advancements in the techniques of inguinal hernia repairs. The two most commonly practiced laparoscopic approaches are the Total Extra Peritoneal (TEP) and Transabdominal Preperitoneal (TAPP) repair. Aim: To compare the outcomes for TEP and TAPP approaches in laparoscopic inguinal hernia surgery in terms of operative time consumed, postoperative pain, duration of hospital stay, complications and recurrence rate when performed by a single surgeon. Materials and Methods: A prospective interventional cohort study was carried out among 70 patients with uncomplicated inguinal hernia. Patients were divided equally into two groups of 35 patients and underwent TAPP and TEP repairs depending on group randomisation. All surgeries were performed by the same surgeon. Factors including operative time, postoperative pain, duration of hospital stay, complications and recurrence were documented and compared for both the groups. The statistical analysis was done using Statistical Package for the Social Sciences (SPSS) software version 21. Unpaired t-test was used to compare the mean between the two groups. The p-value of <0.05 was considered to be statistically significant. Results: The mean operative time measured in minutes for TEP repair was 31.03 minutes and TAPP repair was 42.26 showing a difference of 11.23 minutes which was statistically significant (p-0.001). The mean Standard Deviation (SD) pain score at 24 hours for TEP repair was 2.43 (1.195) and TAPP repair was 3.43 (0.917). The mean (SD) pain score at 48 hours for TEP repair was 1.31 (1.051) and TAPP repair was 2.20 (0.901). The mean (SD) pain score at one week for TEP repair was 0.37 (0.690) and TAPP repair was 0.91 (0.781). The mean (SD) duration of hospital stay in TEP repair was 2.60 days (0.553) when compared to 3.49 days (0.658) in TAPP repair. All the results were statistically significant with a p-value of 0.001. Conclusion: TEP repair had superior outcomes in terms of reduction in operative time, less postoperative pain and shorter hospital stay than TAPP repair.

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