Background: Total thyroidectomy is the most common endocrine surgery performed in hospitals worldwide. Thyroid
gland is a highly vascularized structure and has a rich supply therefore; delicate techniques must be used in its excision.
Classical techniques have been used for decades with adequate outcomes but have been associated with numerous dismal
complications. The use of harmonic scalpel in thyroid surgery made a breakthrough by decreasing these complications.
This study aims to compare two techniques (Harmonic scalpel vs. Classical techniques) by measuring the differences in
duration of operative time, amount of blood loss, and other inadvertent complications.
Methods: This is a prospective observational cross-sectional study in which 80 patients were included and operated
on at Azadi Teaching Hospital, Kirkuk, Iraq. They were divided into two equal groups, group harmonic scalpel (40
patients) that had total thyroidectomy by harmonic scalpel and group classical techniques (40 patients) that had total
thyroidectomy by classical techniques by means of electrocautery and knot-tying.
Results: Harmonic scalpel group showed a significant reduction in operative time (p value = 0.004), amount of intra-
operative blood loss (p value <0.001), postoperative fluid drainage (p value <0.001) while there were no significant
differences between the two groups in risk of laryngeal nerve injury or length of hospital stay.
Conclusion: Focused harmonic scalpel was an effective and reliable technique in performing safe total thyroidectomies
and had the advantages over other classical techniques in reducing the operative time, amount of intra-operative blood
loss, postoperative fluid drainage with parallel other postoperative complications.