The use of the harmonic scalpel versus knot tying for modified radical neck dissection

Background. Although the utility of the harmonic scalpel (HS) in thyroidectomy has been extensively demonstrated, there is little experience regarding its use for neck dissections. Methods. Within 10 years, 119 patients underwent modified radical neck dissection (MRND) for thyroid cancer. In 51 patients, MRND was performed using conventional knot tying and in 68 using the HS. The number of lymph nodes (LNs) removed, operative time, estimated blood loss (EBL), drain output, duration of the drainage, and complications were compared for 47 patients undergoing first-time unilateral MRND without concomitant additional surgical procedures. Results. The number of LNs removed, operative time, duration of drainage, and rate of lymphatic leak were similar between groups. For the HS group, EBL (5 ± 3 vs 32 ± 10; P =.006) and drain output on postoperative day 1 (51.7 ± 6.2 vs 78.9 ± 11.9; P =.02) and at 1 week (6.1 ± 1.2 vs 10.2 ± 1.8, respectively; P =.03) were significantly less. Conclusion. Despite the limitations of its retrospective nature, this study shows that the HS reduces EBL and the amount of lymphatic drainage compared to knot tying after MRND.