Use of Harmonic Scalpel and Bipolar Coagulation Forceps Versus Harmonic Scalpel and Conventional Clampand-Tie Technique in Open Thyroid Surgery —— A Randomized Controlled Trial_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WEI Tao , ZHANG Ming , LI Jieqing , ZHU Jingqiang

Department of Thyroid and Breast Surgery， West China Hospital， Sichuan University，Chengdu 610041， Sichuan Province， China;

Corresponding author：

Keywords：

Harmonic scalpel; Thyroid surgery; Bipolar coagulation forceps; Recurrent laryngeal nerve paralysis; Hypoparathyroidism

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective 　To compare the advantages and disadvantages of using the harmonic scalpel and bipolar coagulation forceps versus harmonic scalpel and conventional clamp-and-tie technique in open thyroid surgery.
Methods 　One hundred patients indicated for thyroid surgery were randomly divided into two groups：the bipolar coagulation forceps group underwent surgery with harmonic scalpel and bipolar coagulation forceps，and the conventional clamp-and-tie group with harmonic scalpel and conventional clamp-and-tie technique，respectively.All operations were performed by the same group of doctors.The total operation time，intraoperative bleeding，mass diameter，postoperative drainage，and surgical complications （postoperative bleeding， postoperative recurrent laryngeal nerve paralysis，seroma，and permanent postoperative hypoparathyroidism） were compared.
Results 　There were 48 valid cases in the bipolar coagulation forceps group， and 49 cases in the conventional clamp-and-tie group. There were no significant differences between two groups patients of age，gender，disease composition，and mass diameter（P＞0.05）.With the same operative approach， the total operation time，intraoperative bleeding，and the incidence of transient postoperative hypoparathyroidism in the bipolar coagulation forceps group were significantly lower than those in the conventional clamp-and-tie group （P＜0.001）.The postoperative drainage in the bipolar coagulation forceps group was more than that in the conventional clamp-and-tie group （P＜0.05）.There was no single case of postoperative bleeding，postoperative recurrent laryngeal nerve paralysis，seroma，and permanent postoperative hypoparathyroidism in both groups.
Conclusions 　The combination of harmonic scapel with bipolar coagulation forceps provides significant advantages over the combination of harmonic scapel with conventional clamp-and-tie technique in open thyroid surgery.

Citation： WEI Tao,ZHANG Ming,LI Jieqing,ZHU Jingqiang. Use of Harmonic Scalpel and Bipolar Coagulation Forceps Versus Harmonic Scalpel and Conventional Clampand-Tie Technique in Open Thyroid Surgery —— A Randomized Controlled Trial. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2012, 19(2): 157-164. doi: Copy

1.	Roye GD，Monchik J，Amaral JF. Endoscopic adrenalectomy using ultrasonic cutting and coagulating[J]. Surg Technol Int，2000，Ⅸ (4)：129-138.
2.	Takao S，Shinchi H，Maemura K，et al. Ultrasonically activated scalpel is an effective tool for cutting the pancreas in biliary-pancreatic surgery：experimental and clinical studies[J]. J Hepatobiliary Pancreat Surg，2000，7(1)：58-62.
3.	Kanehira E，Omura K，Kinoshita T，et al. How secure are the arteries occluded by a newly developed ultrasonically activated device?[J]. Surg Endosc，1999，13(4)：340-342.
4.	Miccoli P，Berti P，Dionigi G，et al. Randomized controlled trial of harmonic scalpel use during thyroidectomy[J]. Arch Otolaryngol Head Neck Surg，2006，132(10)：1069-1073.
5.	Siperstein AE，Berber E，Morkoyun E. The use of the harmonic scalpel vs conventional knot tying for vessel ligation in thyroid surgery[J]. Arch Surg，2002，137(2)：137-142.
6.	Cordón C，Fajardo R，Ramírez J，et al. A randomized，prospective，parallel group study comparing the Harmonic Scalpel to electrocautery in thyroidectomy[J]. Surgery，2005，137(3)： 337-341.
7.	Shemen L. Thyroidectomy using the harmonic scalpel：analysis of 105 consecutive cases[J]. Otolaryngol Head Neck Surg，2002，127(4)：284-288.
8.	Voutilainen PE，Haglund CH. Ultrasonically activated shears in thyroidectomies：a randomized trial[J]. Ann Surg，2000，231 (3)：322-328.
9.	张冬坤，郭朱明，张诠，等 .超声刀在开放性甲状腺手术中的应用[ J].中国耳鼻咽喉头颈外科，2006，13(6)：369-371.
10.	张彬，安常明，徐震纲，等 .超声刀在甲状腺手术中的应用[J]. 中国耳鼻咽喉头颈外科，2006，13(6)：365-367．.
11.	魏涛，李志辉，朱精强 . 超声刀与传统方法在开放甲状腺手术的临床对比研究[ J]. 中国普外基础与临床杂志， 2008，15 (5)：323-326．.
12.	Bulsara KR，Sukhla S，Nimjee SM. History of bipolar coagulation[J]. Neurosurg Rev，2006，29(2)：93-96.
13.	Giles Y，Boztepe H，Terzioglu T，et al. The advantage of total thyroidectomy to avoid reoperation for incidental thyroid cancer in multinodular goiter[J]. Arch Surg，2004，139(2)：179-182.
14.	Zambudio AR，Rodríguez J，Riquelme J，et al. Prospective study of postoperative complications after total thyroidectomy for multinodular goiters by surgeons with experience in endocrine surgery[J]. Ann Surg，2004，240(1)：18-25.
15.	Veyseller B，Aksoy F，Demirhan H，et al. Total thyroidectomy in benign thyroid diseases[J]. Kulak Burun Bogaz Ihtis Derg，2009，19(6)：299-303.
16.	Friguglietti CU，Lin CS，Kulcsar MA. Total thyroidectomy for benign thyroid disease[J]. Laryngoscope，2003，113(10)： 1820-1826.
17.	Yen WY，Qiu W. The feasibility of total or near-total bilateral thyroidectomy for the treatment of bilateral multinodular goiter[J]. J Invest Surg，2009，22(3)：195-200.
18.	Hussain M，Hisham AN. Total thyroidectomy：the procedure of choice for toxic goitre[J]. Asian J Surg，2008，31(2)： 59-62．.
19.	Colak T，Akca T，Kanik A，et al. Total versus subtotal thyroidectomy for the management of benign multinodular goiter in an endemic region[J]. ANZ J Surg，2004，74(11)：974-978.
20.	Chiang FY，Lin JC，Wu CW，et al. Morbidity after total thyroidectomy for benign thyroid disease：comparison of Graves’ disease and non-Graves’ disease[J]. Kaohsiung J Med Sci，2006，22(11)：554-559.
21.	Ayache S，Tramier B，Chatelain D，et al. Evolution of the thyroid surgical treatment to the total thyroidectomy. Study of about 735 patients[J]. Ann Otolaryngol Chir Cervicofac，2005，122(3)：127-133.
22.	Ku CF，Lo CY，Chan WF，et al. Total thyroidectomy replaces subtotal thyroidectomy as the preferred surgical treatment for graves’ disease[J]. ANZ J Surg，2005，75(7）：528-531.
23.	Vaiman M，Nagibin A，Hagag P，et al. Subtotal and near total versus total thyroidectomy for the management of multinodular goiter[J]. World J Surg，2008，32(7)：1546-1551.
24.	Halsted WS，Evans HM. I. the parathyroid glandules. Their blood supply and their preservation in operation upon the thyroid gland[J]. Ann Surg，1907，46(4)：489-506.
25.	Thompson NW，Olsen WR，Hoffman GL. The continuing development of the technique of thyroidectomy[J]. Surgery，1973， 73(6)：913-927.
26.	Tysome JR，Hassan R，Davis J. Standard bipolar diathermy forceps vessel ligation is safe in thyroidectomy[J]. Eur Arch Otorhinolaryngol，2009，266(11)：1781-1786.
27.	Franko J，Kish KJ，Pezzi CM，et al. Safely increasing the efficiency of thyroidectomy using a new bipolar electrosealing device (LigaSure) versus conventional clamp-and-tie technique[J]. Am Surg，2006，72(2)：132-136.
28.	Manouras A，Markogiannakis H，Koutras AS，et al. Thyroid surgery：comparison between the electrothermal bipolar vessel sealing system，harmonic scalpel，and classic suture ligation[J]. Am J Surg，2008，195(1)：48-52.
29.	Dror A， Salim M，Yoseph R. Sutureless thyroidectomy using electrothermal system：a new technique[J]. J Laryngol Otol，2003，117(3)：198-201.
30.	Manouras A，Lagoudianakis EE，Antonakis PT，et al. Electrothermal bipolar vessel sealing system is a safe and time-saving alternative to classic suture ligation in total thyroidectomy[J]. Head Neck，2005，27(11)：959-962.
31.	李文秀，金晓杰，李吉平，等 .甲状腺切除术中双极电凝与钳扎止血的应用比较[ J].中国耳鼻咽喉头颈外科，2009，16 (6)：309-310．.
32.	高力，谢磊，叶学红，等 .甲状腺全切除或近全切除术治疗 180例甲状腺癌的手术体会[ J].外科理论与实践， 2003， 8(4)：300-303．.
33.	闫利英，李随勤，张少强，等 .甲状腺全切及近全切术中甲状旁腺的原位保护[ J].临床耳鼻咽喉科杂志，2006，20(21)： 980-982．.
34.	Nobori M，Saiki S，Tanaka N，et al. Blood supply of the parathyroid gland from the superior thyroid artery[J]. Surgery， 1994，115(4)：417-423.
35.	Asari R，Passler C，Kaczirek K，et al. Hypoparathyroidism after total thyroidectomy：a prospective study[J]. Arch Surg，2008，143(2)：132-137.
36.	Falk S. Complications of Thyroid Surgery：Hypocalcemia，H ypoparathyroidism[M]. New York，NY：Raven，1990：98123.
37.	Reeve T，Thompson NW. Complications of thyroid surgery： how to avoid them，how to manage them，and observations on their possible effect on the whole patient[J]. World J Surg，2000，24(8)：971-975.
38.	Lombardi CP，Raffaelli M，Princi P，et al. Early prediction of postthyroidectomy hypocalcemia by one single iPTH measurement[J]. Surgery，2004，136(6)：1236-1241.
39.	Wilson RB，Erskine C，Crowe PJ. Hypomagnesemia and hypocalcemia after thyroidectomy：prospective study[J]. World J Surg，2000，24(6)：722-726.
40.	Kihara M，Yokomise H，Miyauchi A，et al. Recovery of parathyroid function after total thyroidectomy[J]. Surg Today， 2000，30(4)：333-338.
41.	Acun Z，Comert M，Cihan A，et al. Near-total thyroidectomy could be the best treatment for thyroid disease in endemic regions[J]. Arch Surg，2004，139(4)：444-447.
42.	Erbil Y，Barbaros U，Salmaslio.lu A，et al. The advantage of near-total thyroidectomy to avoid postoperative hypoparathyroidism in benign multinodular goiter[J]. Langenbecks Arch Surg，2006，391(6)：567-573．.
43.	Unalp HR，Erbil Y，Akguner T，et al. Does near total thyroidectomy offer advantage over total thyroidectomy in terms of postoperative hypocalcemia?[J]. Int J Surg，2009，7(2)：120125.
44.	龚日祥，张敏，罗书画，等 . 甲状腺手术中常规显露喉返神[55]陈世彩，郑宏良，周水淼，等 . 甲状腺手术喉返神经损伤规经的安全性分析[ J].四川大学学报 (医学版 )，2008，39(3)：律及治疗的探讨[ J].中华耳鼻咽喉科杂志， 2004，39(8)： 464-466．464-468．.
45.	张海添，陆云飞，廖清华，等 . 甲状腺手术中显露喉返神经[56]周建平，牛俊波，袁建明，等 . 甲状腺手术中喉返神经损伤价值的 Meta分析[ J].中华普通外科杂志，2005，20(4)：204-的预防及处理[ J]. 外科理论与实践，2007，12(4)：345-347.206．[57] Agarwal G，Aggarwal V. Is total thyroidectomy the surgical.
46.	刘连新，武林枫，刘冰，等 . 显露喉返神经的甲状腺手术 procedure of choice for benign multinodular goiter? An evidence574例[ J].中国普通外科杂志，2004，13(5)：340-342．based review[J]. World J Surg，2008，32(7)：1313-1324.
47.	Jatzko GR，Lisborg PH，Müller MG，et al. Recurrent nerve [58] Shrime MG，Goldstein DP，Seaberg RM，et al. Cost-effective palsy after thyroid operations－principal nerve identification management of low-risk papillary thyroid carcinoma[J]. Arch and a literature review[J]. Surgery，1994，115(2)：139-144.Otolaryngol Head Neck Surg，2007，133(12)：1245-1253.
48.	Canbaz H，Dirlik M，Colak T，et al. Total thyroidectomy [59] Mazzaferri EL，Massoll N. Management of papillary and is safer with identification of recurrent laryngeal nerve[J]. J follicular (differentiated) thyroid cancer：new paradigms Zhejiang Univ Sci B，2008，9(6)：482-488.using recombinant human thyrotropin[J]. Endocr Relat.
49.	Lo CY，Kwok KF，Yuen PW. A prospective evaluation of recu-cancer，2002，9(4)：227-247．rrent laryngeal nerve paralysis during thyroidectomy[J]. Arch Surg，2000，135(2)：204-207.
50.	武林枫，刘连新，赵明，等. 甲状腺手术中显露喉返神经的意义 [J]. 中华普通外科杂志， 2005， 20(2)： 92-94．.
51.	陈世彩，郑宏良，周水淼，等. 甲状腺手术喉返神经损伤规律及治疗的探讨 [J]. 中华耳鼻咽喉科杂志， 2004， 39(8)：464-468．.
52.	周建平，牛俊波，袁建明，等. 甲状腺手术中喉返神经损伤的预防及处理 [J]. 外科理论与实践， 2007， 12(4)： 345-347.
53.	Agarwal G， Aggarwal V. Is total thyroidectomy the surgical procedure of choice for benign multinodular goiter? An evidencebased review [J]. World J Surg， 2008， 32(7)： 1313-1324.
54.	Shrime MG， Goldstein DP， Seaberg RM， et al. Cost-effective management of low-risk papillary thyroid carcinoma [J]. Arch Otolaryngol Head Neck Surg， 2007， 133(12)： 1245-1253.
55.	Mazzaferri EL， Massoll N. Management of papillary and follicular (differentiated) thyroid cancer： new paradigms using recombinant human thyrotropin [J]. Endocr Relatcancer， 2002， 9(4)： 227-247．.

1. Roye GD，Monchik J，Amaral JF. Endoscopic adrenalectomy using ultrasonic cutting and coagulating[J]. Surg Technol Int，2000，Ⅸ (4)：129-138.
2. Takao S，Shinchi H，Maemura K，et al. Ultrasonically activated scalpel is an effective tool for cutting the pancreas in biliary-pancreatic surgery：experimental and clinical studies[J]. J Hepatobiliary Pancreat Surg，2000，7(1)：58-62.
3. Kanehira E，Omura K，Kinoshita T，et al. How secure are the arteries occluded by a newly developed ultrasonically activated device?[J]. Surg Endosc，1999，13(4)：340-342.
4. Miccoli P，Berti P，Dionigi G，et al. Randomized controlled trial of harmonic scalpel use during thyroidectomy[J]. Arch Otolaryngol Head Neck Surg，2006，132(10)：1069-1073.
5. Siperstein AE，Berber E，Morkoyun E. The use of the harmonic scalpel vs conventional knot tying for vessel ligation in thyroid surgery[J]. Arch Surg，2002，137(2)：137-142.
6. Cordón C，Fajardo R，Ramírez J，et al. A randomized，prospective，parallel group study comparing the Harmonic Scalpel to electrocautery in thyroidectomy[J]. Surgery，2005，137(3)： 337-341.
7. Shemen L. Thyroidectomy using the harmonic scalpel：analysis of 105 consecutive cases[J]. Otolaryngol Head Neck Surg，2002，127(4)：284-288.
8. Voutilainen PE，Haglund CH. Ultrasonically activated shears in thyroidectomies：a randomized trial[J]. Ann Surg，2000，231 (3)：322-328.
9. 张冬坤，郭朱明，张诠，等 .超声刀在开放性甲状腺手术中的应用[ J].中国耳鼻咽喉头颈外科，2006，13(6)：369-371.
10. 张彬，安常明，徐震纲，等 .超声刀在甲状腺手术中的应用[J]. 中国耳鼻咽喉头颈外科，2006，13(6)：365-367．.
11. 魏涛，李志辉，朱精强 . 超声刀与传统方法在开放甲状腺手术的临床对比研究[ J]. 中国普外基础与临床杂志， 2008，15 (5)：323-326．.
12. Bulsara KR，Sukhla S，Nimjee SM. History of bipolar coagulation[J]. Neurosurg Rev，2006，29(2)：93-96.
13. Giles Y，Boztepe H，Terzioglu T，et al. The advantage of total thyroidectomy to avoid reoperation for incidental thyroid cancer in multinodular goiter[J]. Arch Surg，2004，139(2)：179-182.
14. Zambudio AR，Rodríguez J，Riquelme J，et al. Prospective study of postoperative complications after total thyroidectomy for multinodular goiters by surgeons with experience in endocrine surgery[J]. Ann Surg，2004，240(1)：18-25.
15. Veyseller B，Aksoy F，Demirhan H，et al. Total thyroidectomy in benign thyroid diseases[J]. Kulak Burun Bogaz Ihtis Derg，2009，19(6)：299-303.
16. Friguglietti CU，Lin CS，Kulcsar MA. Total thyroidectomy for benign thyroid disease[J]. Laryngoscope，2003，113(10)： 1820-1826.
17. Yen WY，Qiu W. The feasibility of total or near-total bilateral thyroidectomy for the treatment of bilateral multinodular goiter[J]. J Invest Surg，2009，22(3)：195-200.
18. Hussain M，Hisham AN. Total thyroidectomy：the procedure of choice for toxic goitre[J]. Asian J Surg，2008，31(2)： 59-62．.
19. Colak T，Akca T，Kanik A，et al. Total versus subtotal thyroidectomy for the management of benign multinodular goiter in an endemic region[J]. ANZ J Surg，2004，74(11)：974-978.
20. Chiang FY，Lin JC，Wu CW，et al. Morbidity after total thyroidectomy for benign thyroid disease：comparison of Graves’ disease and non-Graves’ disease[J]. Kaohsiung J Med Sci，2006，22(11)：554-559.
21. Ayache S，Tramier B，Chatelain D，et al. Evolution of the thyroid surgical treatment to the total thyroidectomy. Study of about 735 patients[J]. Ann Otolaryngol Chir Cervicofac，2005，122(3)：127-133.
22. Ku CF，Lo CY，Chan WF，et al. Total thyroidectomy replaces subtotal thyroidectomy as the preferred surgical treatment for graves’ disease[J]. ANZ J Surg，2005，75(7）：528-531.
23. Vaiman M，Nagibin A，Hagag P，et al. Subtotal and near total versus total thyroidectomy for the management of multinodular goiter[J]. World J Surg，2008，32(7)：1546-1551.
24. Halsted WS，Evans HM. I. the parathyroid glandules. Their blood supply and their preservation in operation upon the thyroid gland[J]. Ann Surg，1907，46(4)：489-506.
25. Thompson NW，Olsen WR，Hoffman GL. The continuing development of the technique of thyroidectomy[J]. Surgery，1973， 73(6)：913-927.
26. Tysome JR，Hassan R，Davis J. Standard bipolar diathermy forceps vessel ligation is safe in thyroidectomy[J]. Eur Arch Otorhinolaryngol，2009，266(11)：1781-1786.
27. Franko J，Kish KJ，Pezzi CM，et al. Safely increasing the efficiency of thyroidectomy using a new bipolar electrosealing device (LigaSure) versus conventional clamp-and-tie technique[J]. Am Surg，2006，72(2)：132-136.
28. Manouras A，Markogiannakis H，Koutras AS，et al. Thyroid surgery：comparison between the electrothermal bipolar vessel sealing system，harmonic scalpel，and classic suture ligation[J]. Am J Surg，2008，195(1)：48-52.
29. Dror A， Salim M，Yoseph R. Sutureless thyroidectomy using electrothermal system：a new technique[J]. J Laryngol Otol，2003，117(3)：198-201.
30. Manouras A，Lagoudianakis EE，Antonakis PT，et al. Electrothermal bipolar vessel sealing system is a safe and time-saving alternative to classic suture ligation in total thyroidectomy[J]. Head Neck，2005，27(11)：959-962.
31. 李文秀，金晓杰，李吉平，等 .甲状腺切除术中双极电凝与钳扎止血的应用比较[ J].中国耳鼻咽喉头颈外科，2009，16 (6)：309-310．.
32. 高力，谢磊，叶学红，等 .甲状腺全切除或近全切除术治疗 180例甲状腺癌的手术体会[ J].外科理论与实践， 2003， 8(4)：300-303．.
33. 闫利英，李随勤，张少强，等 .甲状腺全切及近全切术中甲状旁腺的原位保护[ J].临床耳鼻咽喉科杂志，2006，20(21)： 980-982．.
34. Nobori M，Saiki S，Tanaka N，et al. Blood supply of the parathyroid gland from the superior thyroid artery[J]. Surgery， 1994，115(4)：417-423.
35. Asari R，Passler C，Kaczirek K，et al. Hypoparathyroidism after total thyroidectomy：a prospective study[J]. Arch Surg，2008，143(2)：132-137.
36. Falk S. Complications of Thyroid Surgery：Hypocalcemia，H ypoparathyroidism[M]. New York，NY：Raven，1990：98123.
37. Reeve T，Thompson NW. Complications of thyroid surgery： how to avoid them，how to manage them，and observations on their possible effect on the whole patient[J]. World J Surg，2000，24(8)：971-975.
38. Lombardi CP，Raffaelli M，Princi P，et al. Early prediction of postthyroidectomy hypocalcemia by one single iPTH measurement[J]. Surgery，2004，136(6)：1236-1241.
39. Wilson RB，Erskine C，Crowe PJ. Hypomagnesemia and hypocalcemia after thyroidectomy：prospective study[J]. World J Surg，2000，24(6)：722-726.
40. Kihara M，Yokomise H，Miyauchi A，et al. Recovery of parathyroid function after total thyroidectomy[J]. Surg Today， 2000，30(4)：333-338.
41. Acun Z，Comert M，Cihan A，et al. Near-total thyroidectomy could be the best treatment for thyroid disease in endemic regions[J]. Arch Surg，2004，139(4)：444-447.
42. Erbil Y，Barbaros U，Salmaslio.lu A，et al. The advantage of near-total thyroidectomy to avoid postoperative hypoparathyroidism in benign multinodular goiter[J]. Langenbecks Arch Surg，2006，391(6)：567-573．.
43. Unalp HR，Erbil Y，Akguner T，et al. Does near total thyroidectomy offer advantage over total thyroidectomy in terms of postoperative hypocalcemia?[J]. Int J Surg，2009，7(2)：120125.
44. 龚日祥，张敏，罗书画，等 . 甲状腺手术中常规显露喉返神[55]陈世彩，郑宏良，周水淼，等 . 甲状腺手术喉返神经损伤规经的安全性分析[ J].四川大学学报 (医学版 )，2008，39(3)：律及治疗的探讨[ J].中华耳鼻咽喉科杂志， 2004，39(8)： 464-466．464-468．.
45. 张海添，陆云飞，廖清华，等 . 甲状腺手术中显露喉返神经[56]周建平，牛俊波，袁建明，等 . 甲状腺手术中喉返神经损伤价值的 Meta分析[ J].中华普通外科杂志，2005，20(4)：204-的预防及处理[ J]. 外科理论与实践，2007，12(4)：345-347.206．[57] Agarwal G，Aggarwal V. Is total thyroidectomy the surgical.
46. 刘连新，武林枫，刘冰，等 . 显露喉返神经的甲状腺手术 procedure of choice for benign multinodular goiter? An evidence574例[ J].中国普通外科杂志，2004，13(5)：340-342．based review[J]. World J Surg，2008，32(7)：1313-1324.
47. Jatzko GR，Lisborg PH，Müller MG，et al. Recurrent nerve [58] Shrime MG，Goldstein DP，Seaberg RM，et al. Cost-effective palsy after thyroid operations－principal nerve identification management of low-risk papillary thyroid carcinoma[J]. Arch and a literature review[J]. Surgery，1994，115(2)：139-144.Otolaryngol Head Neck Surg，2007，133(12)：1245-1253.
48. Canbaz H，Dirlik M，Colak T，et al. Total thyroidectomy [59] Mazzaferri EL，Massoll N. Management of papillary and is safer with identification of recurrent laryngeal nerve[J]. J follicular (differentiated) thyroid cancer：new paradigms Zhejiang Univ Sci B，2008，9(6)：482-488.using recombinant human thyrotropin[J]. Endocr Relat.
49. Lo CY，Kwok KF，Yuen PW. A prospective evaluation of recu-cancer，2002，9(4)：227-247．rrent laryngeal nerve paralysis during thyroidectomy[J]. Arch Surg，2000，135(2)：204-207.
50. 武林枫，刘连新，赵明，等. 甲状腺手术中显露喉返神经的意义 [J]. 中华普通外科杂志， 2005， 20(2)： 92-94．.
51. 陈世彩，郑宏良，周水淼，等. 甲状腺手术喉返神经损伤规律及治疗的探讨 [J]. 中华耳鼻咽喉科杂志， 2004， 39(8)：464-468．.
52. 周建平，牛俊波，袁建明，等. 甲状腺手术中喉返神经损伤的预防及处理 [J]. 外科理论与实践， 2007， 12(4)： 345-347.
53. Agarwal G， Aggarwal V. Is total thyroidectomy the surgical procedure of choice for benign multinodular goiter? An evidencebased review [J]. World J Surg， 2008， 32(7)： 1313-1324.
54. Shrime MG， Goldstein DP， Seaberg RM， et al. Cost-effective management of low-risk papillary thyroid carcinoma [J]. Arch Otolaryngol Head Neck Surg， 2007， 133(12)： 1245-1253.
55. Mazzaferri EL， Massoll N. Management of papillary and follicular (differentiated) thyroid cancer： new paradigms using recombinant human thyrotropin [J]. Endocr Relatcancer， 2002， 9(4)： 227-247．.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Use of Harmonic Scalpel and Bipolar Coagulation Forceps Versus Harmonic Scalpel and Conventional Clampand-Tie Technique in Open Thyroid Surgery —— A Randomized Controlled Trial

Abstract Full text Figures/Tables Video References Cited by

Format

Content