Thyroid surgery with a harmonic scalpel: an experimental study

Background: The goal of the study was to determinate the safety of the harmonic scalpel, widely used in thyroidectomy, near the recurrent laryngeal nerve (RLN). Methods: The study involved ten pigs of either sex. Twenty RLNs at risk were dissected using the new harmonic scalpel FOCUS. The distances between the nerve and the activated instrument were checked with a millimeter ruler. After dissection, the pigs were euthanized, and both RLNs were fixed in formol and examined by histology after staining with hematoxylin-eosin. Due to technical reasons, only 18 RLNs from the ten pigs could be examined. Results: In the experiment that investigated the extent of heat injury, ultrasonic dissection did not cause any immediate damage of the nerve even close to the RLN (1 mm away from the RLN). Conclusion: The use of harmonic scalpel FOCUS for thyroid surgery is safe for the surrounding structures (nerves). Careful tissue applications of the device near the RLN (1 mm) did not cause any lesion histologically.