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A systematic review and meta-analysis of Harmonic Focus in thyroidectomy compared to conventional techniques.

Cheng H, Soleas I, Ferko NC, Clymer JW, Amaral JF - Thyroid Res (2015)

Bottom Line: Meta-analysis was performed using random effects models with the inverse-variance method for mean differences of continuous variables and the Mantel-Haenszel method for risk ratios of dichotomous variables.A total of 14 studies met the inclusion criteria.This is the first meta-analysis of Harmonic Focus in thyroid surgery.

View Article: PubMed Central - PubMed

Affiliation: Ethicon Inc, 4545 Creek Rd, Cincinnati, OH 45242 USA.

ABSTRACT

Introduction: Several meta-analyses have been performed comparing the use of a variety of ultrasonic devices in thyroidectomy to conventional procedures. These studies have shown the superiority of ultrasonic devices for most outcomes studied including faster operative time and less blood loss, and equivalent or better safety for recurrent laryngeal nerve paresis and hypocalcemia. The current work is the first to examine a single ultrasonic device specifically designed for thyroid surgery, the Harmonic Focus, in order to confirm its efficacy and safety in thyroidectomy.

Methods: A comprehensive literature search without language restrictions was performed for randomized clinical trials comparing Harmonic Focus and conventional clamp, cut and tie in thyroidectomy. Outcome measures included operating time, blood loss, post-operative pain, length of hospital stay, hypocalcemia and recurrent laryngeal nerve paresis. Risk of bias was analyzed for all studies. Meta-analysis was performed using random effects models with the inverse-variance method for mean differences of continuous variables and the Mantel-Haenszel method for risk ratios of dichotomous variables.

Results: A total of 14 studies met the inclusion criteria. Harmonic Focus reduced operative time by 29 min, a 31 % decrease (p < 0.001), intra-operative blood loss by 45 ml (p < 0.001), post-operative pain (p < 0.001), length of hospital stay by 0.68 days (p = 0.005), drainage volume by 29 ml (p = 0.01), and occurrence of transient hypocalcemia by 40 % (p = 0.001). There were no significant differences between Harmonic Focus and conventional procedures in rate of persistent hypocalcemia, or rates of transient and persistent recurrent laryngeal nerve paresis.

Conclusion: This is the first meta-analysis of Harmonic Focus in thyroid surgery. In agreement with meta-analyses previously performed on ultrasonic devices, use of the Harmonic Focus has been shown to be a more effective surgical procedure compared to conventional methods in thyroidectomy. The low occurrence of hypocalcemia and recurrent laryngeal nerve paresis confirms that Harmonic Focus can improve thyroidectomy efficiency without increasing the risk of complications.

No MeSH data available.


Related in: MedlinePlus

PRISMA diagram for the systematic literature review
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Related In: Results  -  Collection

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Fig1: PRISMA diagram for the systematic literature review

Mentions: The systematic search resulted in the identification of 4542 total records, of which 4153 were excluded following title and abstract screening (Fig. 1). Of the 389 full text articles retrieved and reviewed, 375 were further excluded if studies were non-RCTs, had an undefined manufacturer, did not use Harmonic Focus, the publication was unavailable and had nonhuman subjects, or the surgical procedure was not total thyroidectomy. Overall, 14 studies consisting of 2516 patients in total reporting on Harmonic device (Focus) use in total thyroidectomy were included in the meta-analysis [8–10, 12–22].Fig. 1


A systematic review and meta-analysis of Harmonic Focus in thyroidectomy compared to conventional techniques.

Cheng H, Soleas I, Ferko NC, Clymer JW, Amaral JF - Thyroid Res (2015)

PRISMA diagram for the systematic literature review
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4589949&req=5

Fig1: PRISMA diagram for the systematic literature review
Mentions: The systematic search resulted in the identification of 4542 total records, of which 4153 were excluded following title and abstract screening (Fig. 1). Of the 389 full text articles retrieved and reviewed, 375 were further excluded if studies were non-RCTs, had an undefined manufacturer, did not use Harmonic Focus, the publication was unavailable and had nonhuman subjects, or the surgical procedure was not total thyroidectomy. Overall, 14 studies consisting of 2516 patients in total reporting on Harmonic device (Focus) use in total thyroidectomy were included in the meta-analysis [8–10, 12–22].Fig. 1

Bottom Line: Meta-analysis was performed using random effects models with the inverse-variance method for mean differences of continuous variables and the Mantel-Haenszel method for risk ratios of dichotomous variables.A total of 14 studies met the inclusion criteria.This is the first meta-analysis of Harmonic Focus in thyroid surgery.

View Article: PubMed Central - PubMed

Affiliation: Ethicon Inc, 4545 Creek Rd, Cincinnati, OH 45242 USA.

ABSTRACT

Introduction: Several meta-analyses have been performed comparing the use of a variety of ultrasonic devices in thyroidectomy to conventional procedures. These studies have shown the superiority of ultrasonic devices for most outcomes studied including faster operative time and less blood loss, and equivalent or better safety for recurrent laryngeal nerve paresis and hypocalcemia. The current work is the first to examine a single ultrasonic device specifically designed for thyroid surgery, the Harmonic Focus, in order to confirm its efficacy and safety in thyroidectomy.

Methods: A comprehensive literature search without language restrictions was performed for randomized clinical trials comparing Harmonic Focus and conventional clamp, cut and tie in thyroidectomy. Outcome measures included operating time, blood loss, post-operative pain, length of hospital stay, hypocalcemia and recurrent laryngeal nerve paresis. Risk of bias was analyzed for all studies. Meta-analysis was performed using random effects models with the inverse-variance method for mean differences of continuous variables and the Mantel-Haenszel method for risk ratios of dichotomous variables.

Results: A total of 14 studies met the inclusion criteria. Harmonic Focus reduced operative time by 29 min, a 31 % decrease (p < 0.001), intra-operative blood loss by 45 ml (p < 0.001), post-operative pain (p < 0.001), length of hospital stay by 0.68 days (p = 0.005), drainage volume by 29 ml (p = 0.01), and occurrence of transient hypocalcemia by 40 % (p = 0.001). There were no significant differences between Harmonic Focus and conventional procedures in rate of persistent hypocalcemia, or rates of transient and persistent recurrent laryngeal nerve paresis.

Conclusion: This is the first meta-analysis of Harmonic Focus in thyroid surgery. In agreement with meta-analyses previously performed on ultrasonic devices, use of the Harmonic Focus has been shown to be a more effective surgical procedure compared to conventional methods in thyroidectomy. The low occurrence of hypocalcemia and recurrent laryngeal nerve paresis confirms that Harmonic Focus can improve thyroidectomy efficiency without increasing the risk of complications.

No MeSH data available.


Related in: MedlinePlus