Safety of the harmonic scalpel versus conventional "clamp-and-tie" approach for intraoperative bleeding control during thyroidectomy: a surgeon's experience in 60 consecutive cases.

Authors

Soniya Shankar Kalpana, G Tilak Ramu, Balaji Durairaj

Published in

Patient safety in surgery. Jul 11, 2026. Epub Jul 11, 2026.

Abstract

Post-thyroidectomy complications including hypocalcemia, recurrent laryngeal nerve injury, and cervical hematoma remain important safety concerns. Although the harmonic scalpel improves operative efficiency, evidence regarding its impact on patient safety outcomes remains limited.
In this prospective observational cohort study, 60 patients undergoing open thyroidectomy were allocated to harmonic scalpel (n = 30) or clamp and tie (n = 30) groups. The primary endpoints were safety outcomes, including hypocalcemia, recurrent laryngeal nerve injury, postoperative hematoma, surgical site infection, and composite complication rates. Secondary endpoints included operative time, intraoperative blood loss, drain output, postoperative pain, and length of hospital stay. Statistical significance was defined as p < 0.05.
Use of the harmonic scalpel was associated with a significant reduction in overall complications compared with the conventional technique (13.3% vs. 33.3%, p = 0.04). Transient hypocalcemia occurred less frequently in the harmonic scalpel group, accompanied by significantly higher postoperative calcium levels at 24 and 48 h. No recurrent laryngeal nerve injury or postoperative hematoma was observed in the harmonic scalpel group, although differences were not statistically significant. In addition to improved safety outcomes, harmonic scalpel use resulted in shorter operative duration, substantially reduced intraoperative blood loss, lower postoperative drain volumes, decreased pain scores, and reduced length of hospital stay.
The harmonic scalpel was associated with improved operative efficiency and a lower overall complication burden without increasing major safety-related complications. Larger randomized multicenter studies are required to confirm these findings.
Not applicable.

PMID:
42436548
Bibliographic data and abstract were imported from PubMed on 12 Jul 2026.

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