Journal of IMAB - Annual Proceeding (Scientific Papers)
Publisher: Peytchinski, Gospodin Iliev
ISSN: 1312 773X
Issue: 2013, vol. 19, book 1;
Subject Collection: Medicine
Published online: 10 June 2013
J of IMAB. 2013; 19(1):412-415;
HARMONIC SCALPEL POSSIBILITIES IN THE SURGICAL TREATMENT OF SECONDARY HYPERPARATHYROIDISM
Rumen Nenkov, Radoslav Radev, Ekaterina Marinova, Nikolay Cvetkov, Anatoli Semkov, Borislav Petrov
Department of Thoracic surgery, UMHAT "St. Marina", Medical University – Varna, Bulgaria.
The significant changes in coagulation status during chroniodialysis, performed in patients with secondary hyperparathyroidism require completion of meticulous surgical hemostasis in order to prevent active bleeding in the postoperative period.
Aim: To present our experience with harmonic scalpel application in the surgical treatment of secondary hyperparathyroidism.
Patients and Methods: 112 patients with secondary hyperparathyroidism (77 males and 35 females, aged from 23 to 60 years) have been operated on in our institution for 10 years period. All patients were on chroniodialysis. Hemostasis was achieved using conventional instruments and electrocautery in 46 patients and in 66 patients harmonic scalpel of Ethicon EndoSurgeryCare has been used. All patients had serum levels of parathormone above 2500ng/l. Ultrasonic examination revealed at least 2 parathyroid glands larger than 10mm in all cases. The amount of blood loss, necessity and type of drainages used, frequency of postoperative complications, postoperative hospital stay were comparatively evaluated.
Results: In 12 patients parathyroidectomy with autotransplantation was carried out, in 62 patients subtotal parathyroidectomy was performed. In the rest 35 cases- three of the parathyroid glands were removed (because of the impossibility to identify the fourth parathyroid gland, using ultrasonic and intraoperative methods). All patients were proven to have a sharp decrease in parathormone and Calcium serum levels. In the group of patients, where conventional instruments and electrocautery for hemostasis have been used, corrugated and tube drainages were applied as a rule. For the patients, in whom hemostasis was performed using a harmonic scalpel, simple glove drainages were used. In all patients in the pre-operative and post-operative period serial hemodialysis was done with LMW heparin administration. Significantly lower blood loss from the surgical wound was found in the group, where harmonic scission was used.
Conclusions: We consider that the application of harmonic scalpel in the surgical treatment of patients with secondary hyperparathyroidism on chroniodialysis leads to safer hemostasis, lower postoperative complications rate and thus shortens the postoperative hospital stay.
Key words: secondary hyperparathyroidism, harmonic scalpel, surgery, auto transplantation.
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Please cite this article as:
Nenkov R, Radev R, Marinova E, Cvetkov N, Semkov A, Petrov B. HARMONIC SCALPEL POSSIBILITIES IN THE SURGICAL TREATMENT OF SECONDARY HYPERPARATHYROIDISM. J of IMAB. 2013; 19(1):412-415. DOI: 10.5272/jimab.2013191.412.
Correspondence to: Rumen Nenkov, MD, PhD; Clinic of Thoracic Surgery, UMHAT "St. Marina", Medical University, Varna; 1 “Hristo Smirnenski” Str., Varna, Bulgaria
1. Nenkov R, Radev R, Madzhov R. Minimally Invasive Open Access Thyoid Surgery - Main Point, Indications and Еffectiveness. Surgery. 2009 LXV(1):24-27. [in Bulgarian]
2. Bellantone R, Lombardi CP, Raffaelli M, Rubino F, Boscherini M, Perilli W. Minimally invasive, totally gasless video-assisted thyroid lobectomy. Am J Surg. 1999 Apr;177(4):342–343. [PubMed] [CrossRef]
3. Ikeda Y, Takami H, Tajima G, Sasaki Y, Takayama J, Kurihara H, et al. Total endoscopic thyroidectomy: axillary or anterior chest approach. Biomed Pharmacother. 2002 56 Suppl 1:72s–78s. [PubMed]
4. Miccoli P, Berti P, Bendinelli C, Conte M, Fasolini F, Martino E. Minimally invasive video-assisted surgery of the thyroid: a preliminary report. Langenbecks Arch Surg. 2000 Jul;385(4):261–264. [PubMed] [CrossRef]
5. Nenkov R, Radev R, Kuzmanov Y, Kornovski S, Kuzmanov S, Nanev B, et al. Argon plasma resection of the thyroid gland - nature and advantages. Surgery. 2005 LXI(3):19-22 [in Bulgarian]
6. Sartori PV, De Fina S, Colombo G, Pugliese F, Romano F, Cesana G, et al. Ligasure versus Ultracision in thyroid surgery: a prospective randomized study. Langenbecks Arch Surg. 2008 Sep;393(5):655-8. Epub 2008; Jul 22. [PubMed] [CrossRef]
7. He Q, Zhuang D, Zheng L, Zhou P, Chai J, Lv Z. Harmonic focus in total thyroidectomy plus level III-IV and VI dissection: a prospective randomized study. World J Surg Oncol. 2011 Oct 31;9:141. [PubMed] [CrossRef]
8. Siperstein AE, Berber E, Morkoyun E. The Use of the Harmonic Scalpel vs Conventional Knot Tying for Vessel Ligation in Thyroid Surgery. Arch Surg. 2002 Feb;137(2):137-142. [PubMed] [CrossRef]
9. Cordòn C, Fajardo R, Ramìrez J, Herrera MF. A randomized, prospective, parallel group study comparing the harmonic scalpel to electrocautery in thyroidectomy. Surgery. 2005 Mar;137(3):337-341. [PubMed] [CrossRef]
10. Ecker T, Carvalho AL, Choe JH, Walosek G, Preuss KJ. Hemostasis in thyroid surgery: harmonic scalpel versus other techniques--a meta-analysis. Otolaryngol Head Neck Surg. 2010 Jul;143(1):17-25. [PubMed] [CrossRef]
11. Foreman E, Aspinall S, Bliss RD, Lennard TW. The Use of the Harmonic Scalpel in Thyroidectomy: ‘Beyond the Learning Curve’. Ann R Coll Surg Engl. 2009 Apr;91(3):214–216. [PubMed] [CrossRef]
12. Markogiannakis H, Kekis PB, Memos N, Alevizos L, Tsamis D, Michalopoulos NV, et al. Thyroid surgery with the new harmonic scalpel: a prospective randomized study. Surgery. 2011 Mar;149(3):411-5. Epub 2010 Sep 18. [PubMed] [CrossRef]
13. Miccoli P, Donatini G. Use of the Harmonic Scalpel in Thyroid Surgery - Review of the Literature. European Endocrine Disease. 2006:54-58.
Accepted for publication: 25 January 2013
Published online: 10 June 2013
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