Total Thyroidectomy with Harmonic Scalpel Combined with Gelatin Thrombin Hemostatic: A Focus on the Elderly Population-A Multicentric Study.
| Title: | Total Thyroidectomy with Harmonic Scalpel Combined with Gelatin Thrombin Hemostatic: A Focus on the Elderly Population-A Multicentric Study. |
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| Authors: | Parisi S; Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania 'Luigi Vanvitelli', via Luigi Pansini n° 5, 80131 Naples, Italy.; Gambardella C; Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania 'Luigi Vanvitelli', via Luigi Pansini n° 5, 80131 Naples, Italy.; Ruggiero R; Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania 'Luigi Vanvitelli', via Luigi Pansini n° 5, 80131 Naples, Italy.; Docimo G; Division of Thyroid Surgery, University of Study of Campania 'Luigi Vanvitelli', 80131 Naples, Italy.; Marotta V; Division of Endocrinology and Diabetology, AOU San Giovanni di Dio e Ruggi d'Aragona, 84131 Salerno, Italy.; Gubitosi A; Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania 'Luigi Vanvitelli', via Luigi Pansini n° 5, 80131 Naples, Italy.; Mongardini FM; Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania 'Luigi Vanvitelli', via Luigi Pansini n° 5, 80131 Naples, Italy.; D'Orazi V; Division of Surgery, Section of Endocrine Surgery and Diabetic Foot Surgery, 'Fabia Mater' Hospital, 00171 Rome, Italy.; Department of Surgery, Sapienza University of Rome, 00185 Rome, Italy.; Fisone F; Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania 'Luigi Vanvitelli', via Luigi Pansini n° 5, 80131 Naples, Italy.; Brusciano L; Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania 'Luigi Vanvitelli', via Luigi Pansini n° 5, 80131 Naples, Italy.; Tolone S; Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania 'Luigi Vanvitelli', via Luigi Pansini n° 5, 80131 Naples, Italy.; Docimo L; Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania 'Luigi Vanvitelli', via Luigi Pansini n° 5, 80131 Naples, Italy.; Lucido FS; Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania 'Luigi Vanvitelli', via Luigi Pansini n° 5, 80131 Naples, Italy. |
| Source: | Medicina (Kaunas, Lithuania) [Medicina (Kaunas)] 2025 Mar 13; Vol. 61 (3). Date of Electronic Publication: 2025 Mar 13. |
| Publication Type: | Journal Article; Multicenter Study |
| Language: | English |
| Journal Info: | Publisher: MDPI Country of Publication: Switzerland NLM ID: 9425208 Publication Model: Electronic Cited Medium: Internet ISSN: 1648-9144 (Electronic) Linking ISSN: 1010660X NLM ISO Abbreviation: Medicina (Kaunas) Subsets: MEDLINE |
| Imprint Name(s): | Publication: 2018- : Basel, Switzerland : MDPI; Original Publication: Kaunas : Lietuvos gydytojų sąjunga |
| MeSH Terms: | Thyroidectomy*/methods ; Thyroidectomy*/instrumentation ; Thyroidectomy*/adverse effects ; Thrombin*/therapeutic use ; Hemostatics*/therapeutic use ; Gelatin Sponge, Absorbable*/therapeutic use ; Hemostasis, Surgical*/methods ; Hemostasis, Surgical*/instrumentation ; Gelatin*/therapeutic use; Blood Loss, Surgical/prevention & control ; Postoperative Complications/epidemiology ; Humans ; Male ; Female ; Aged ; Retrospective Studies ; Middle Aged ; Aged, 80 and over |
| Abstract: | Background and Objectives: With the increasing life expectancy, the frequency of total thyroidectomies in elderly patients has risen, raising concerns regarding hemorrhage and recurrent laryngeal nerve palsy compared to the general population. Therefore, considering the frequent alteration of the coagulation status in such patients, innovative methods able to reach an accurate hemostasis appear highly desirable. This retrospective multicentric study aimed to compare the postoperative outcomes of patients treated with conventional hemostasis with patients treated with the Harmonic Scalpel (HS) and gelatin-thrombin matrix (Floseal). Materials and Methods: Patients undergoing total thyroidectomy were retrospectively enrolled and categorized into two groups: Group A patients underwent surgery with the Harmonic Scalpel and Floseal, while Group B underwent traditional hemostasis surgery with ligations and monopolar electrocautery. The primary endpoint was the drain output after 24 and 48 h and the presence of significant blood loss. Secondary endpoints included the presence of seroma, wound infection, hematoma, laryngeal nerve palsy, surgery duration, and onset of post-surgical hypocalcemia. Results: From January 2014 to January 2024, 870 individuals participated in the study. Group A (gelatin-thrombin and HS) comprised 502 patients, while Group B (Standard Hemostasis-control group) comprised 368 patients. The 24 h drain output was 52 ± 25 mL in Group A vs. 113 ± 27 mL in Group B, p = 0.003, while the 48 h drain output was 95 ± 29 mL in Group A and 113 ± 27 mL in Group B (p = 0.002). Significant blood loss occurred in eight patients (2.2%) of Group B vs. three cases (0.6%) in Group A (p = 0.039). Also, neck hematoma (p = 0.012), seroma (p = 0.005), and reoperation (p = 0.052) values were significantly lower in Group A. Conclusions: Surgery aided with HS, and gelatin-thrombin was associated with lower major and minor complications compared to the conventional approach, guarantying reduced operative time, ensuring hemostasis, and preserving parathyroid glands, even in elderly patients. |
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| Contributed Indexing: | Keywords: Floseal; elderly; gelatin–thrombin matrix; harmonic scalpel; total thyroidectomy |
| Substance Nomenclature: | EC 3.4.21.5 (Thrombin); 0 (Hemostatics); 9000-70-8 (Gelatin); 0 (FloSeal Matrix) |
| Entry Date(s): | Date Created: 20250327 Date Completed: 20250327 Latest Revision: 20250521 |
| Update Code: | 20260130 |
| PubMed Central ID: | PMC11943682 |
| DOI: | 10.3390/medicina61030496 |
| PMID: | 40142307 |
| Database: | MEDLINE |
Journal Article; Multicenter Study