Complications in thyroid surgery. Harmonic Scalpel, Harmonic Focus versus Conventional Hemostasis: A meta-analysis
| Autor: | Celestino Pio Lombardi, Walter Ricciardi, Serafino Vanella, Luca Revelli, Caterina Bianca Neve Aurora Bianchi, Marco Raffaelli, Gianfranco Damiani |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
medicine.medical_specialty
Randomization Blinding Settore MED/18 - CHIRURGIA GENERALE Operative Time Population Blood Loss Surgical Thyroid Gland Harmonic Focus 03 medical and health sciences Postoperative Complications 0302 clinical medicine Harmonic scalpel Humans Medicine Postoperative Period education Complications in thyroidectomy Harmonic Scalpel Hemostasis Thyroid Thyroid surgery Ultrasonic dissector Ultrasonic scalpel education.field_of_study business.industry Incidence (epidemiology) General Medicine Length of Stay Surgical Instruments Hemostasis Surgical Surgery medicine.anatomical_structure 030220 oncology & carcinogenesis Meta-analysis Thyroidectomy Drainage Female 030211 gastroenterology & hepatology business |
| Popis: | Background To 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). Methods The 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. Results There 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. Conclusions HS 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. |
| Databáze: | OpenAIRE |
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