***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND The ultrasonic dissector ( UD ) is an instrument that uses vibration to coagulate and cut tissue simultaneously . The main advantage of a UD instrument compared with a st and ard electrosurgical device is represented by minimal lateral thermic tissue damage allowing a wide application in thyroid surgery . A new UD ( NUD ) , with a tip smaller than 5 mm , might enable a more precise dissection near vital structures such as parathyroid gl and s and recurrent laryngeal nerve . To evaluate the NUD during thyroid surgery , a prospect i ve r and omized study was performed using the new device versus traditional procedures . SUBJECTS AND METHODS Two hundred sixty-one patients underwent various thyroid surgical procedures ; they were r and omly assigned ( 130 in the NUD group and 131 in the conventional hemostasis [ CH ] group ) . The two surgical groups were compared in age , sex , diagnosis , thyroid size , operative time , drainage volume during the first 24 - 48 hours after surgery , and complications ( hypoparathyroidism , damage of the recurrent laryngeal nerve , and postoperative pain ) . RESULTS The two groups were similar regarding age , sex , numbers of lobectomies and total thyroidectomies , and numbers of focal and diffuse pathologies . Mean ± st and ard deviation operative time was shorter in the NUD group compared with the CH group for both lobectomy ( 70 ± 21 minutes versus 99 ± 27 minutes ; P<.01 ) and total thyroidectomy ( 91 ± 37 minutes versus 121 ± 42 minutes ; P=.01 ) procedures . No difference was found regarding the amount of drainage volume for different procedures ( P = not significant ) . Postoperative transient ( P=.01 ) and definitive ( P=.01 ) hypoparathyroidism occurred more frequently in the CH group than in the NUD group . There was a significant difference regarding the transient damage of the recurrent laryngeal nerve : 7 patients ( 5.3 % ) in the NUD group and 13 patients ( 9.8 % ) in the CH group ( P=.01 ) . There was no difference regarding definitive damage to the recurrent laryngeal nerve and pain . CONCLUSION This NUD  may reduce the rate of complications ( transient and definitive hypocalcemia , transient damage of the recurrent laryngeal nerve ) and operative time Purpose We evaluated the safety and cost-effectiveness of the harmonic scalpel ( HS ) during conventional “ open ” thyroidectomy ( CT ) . Material s and methods Two hundred patients scheduled for conventional total thyroidectomy ( TT ) were included in the study and r and omly assigned to TT with the use of HS ( HS group ) or with knot tying technique ( KT group ) . Results Mean operative time was significantly shorter in the HS group ( P < 0.001 ) , as well as the total operative room occupation time ( P < 0.001 ) . The cost of the disposable material s is significantly higher in the HS group ( 420.1 ± 23.2 vs 137.8 ± 25.3 euros ; P < 0.001 ) . Conversely , drugs , personnel and operative room charges were significantly higher in KT group patients ( P < 0.001 ) . Overall , no significant difference was found between the two groups concerning the charges of the hospitalisation ( P = NS ) . Conclusions HS is a safe alternative to KT , allowing for a significant reduction of operative time without increasing complications rate and overall costs and probably better utilization of health re sources Background : One of the most important aspects of thyroid surgery is hemostasis . The ultrasonically activated scalpel is described as a very useful instrument in thyroid surgery for the dissection and sealing of vessels . Our study compares the short-term results of endocrine surgery , with and without the use of ultrasonic devices . Methods : In a prospect ively r and omized trial , 96 patients with endemic goiter were operated by the same surgeon , one study group ( n = 54 patients ) being operated with the ultrasonic scalpel as an additional instrument . We measured the operating time , the number of ligatures needed as well as intraoperative and postoperative bleeding as surrogate markers for improvement of the surgical technique . Results : The ultrasound dissection technique significantly reduces surgery time ( p = 0.048 ; ultrasound procedure average 68 min , conventional procedure average 83 min ) , intraoperative bleeding ( p = 0.028 ) and the number of ligatures ( p = 0.008 ; ultrasound procedure average 8.2 , conventional procedure average 26.4 ) . Conclusions : The use of an ultrasonically activated scalpel significantly improves bleeding control during thyroid resections and may also be beneficial with respect to cost reduction . Clinical application and further studies to characterize its role are justified Introduction Thyrotoxicosis is often considered to be the most difficult thyroid operation because of the high vascularisation and the risk of bleeding . The conventional haemostatic technique in thyroidectomy today include knot tying and electrocoagulation . The introduction of the harmonic scalpel ( HS ) has led to further research if the use of the HS has any benefits in thyroid surgery . To our knowledge , no previous study has evaluated the HS dissection technique in a homogenous group of patients with Graves ’ disease undergoing total thyroidectomy . Material s and methods Fifty-one patients ( 39 women and 12 men ) with the pre-operative diagnosis of Graves ’ disease treated at two endocrine centers were r and omised to total thyroidectomy with the use of the HS or with conventional haemostatic techniques .  Results Twenty-seven patients were r and omised to the harmonic group and 24 to the conventional group . The operating time was shorter in the HS group ( median , 121 min ; range , 84–213 min ) compared to the conventional group ( median , 172 min ; range , 66–268 min ; p = 0.011 ) . Conclusion The use of the HS was associated with a significant reduction in operating time compared to the use of the conventional haemostatic techniques in patients with Graves ’ disease undergoing total thyroidectomy Introduction Thyroidectomy is among the most commonly performed procedures involving the endocrine gl and s and the development of advanced surgical methods combined with a strife for performing the operation in a manner that is minimally invasive for the patient has considerably increased the need for instruments that would limit surgical trauma . Aim To compare of the outcomes of total thyroidectomy operations with and without the use of ultrasonic harmonic FOCUS dissecting shears . Material and methods Eighty-two patients with a bilateral , non-toxic multinodular goiter were r and omized to two groups of 41 patients each .  Total thyroidectomy was performed in each patient . In the clip-ligation group ( CL-G ) , during thyroidectomy , the superior thyroid vessels were clipped and bipolar coagulation was used to secure smaller vessels , whereas in the harmonic FOCUS group ( HF-G ) , a harmonic device was used to dissect and divide all the thyroid vessels . The statistical analysis included the mean operative time , blood loss , postoperative morbidity and cost-effectiveness . Results HF-G vs. CL-G operations were shorter ( 45.4 ±8.7 min vs. 64.5 ±14.2 min ; p < 0.001 ) , characterized by a lower mean blood loss ( 29.9 ±9.8 ml vs. 56.8 ±11.0 ml ; p < 0.001 ) and appeared to be more cost-effective ( 666.2 ±37.5 EUR vs. 718.0 ±69.2 EUR ; p < 0.01 ) . No major complications were observed in both groups . Conclusions In total thyroidectomy operations , the harmonic FOCUS is safe and facilitates dissection , allowing for a significant decrease in operative time . Other benefits include lower blood loss and a slightly decreased cost of the procedure OBJECTIVE The aim of this r and omized study is to evaluate the real benefits of the FOCUS Harmonic Scalpel in total thyroidectomies compared with conventional ligation , regarding operative time , postoperative blood loss , length of stay and complications . Furthermore , as never seen in other studies , we studied the effects of using the FOCUS during thyroidectomy analyzing the vocal production of patients before and after surgery . PATIENTS AND METHODS We enrolled 361 patients who underwent total thyroidectomy from 2008 to 2014 . It was a r and omized clinical trial in which all the surgical procedures were performed by the same surgeon . Patients were r and omized into two groups according to the haemostatic technique : 187 patients were included in a " conventional " group ( C ) in whom dissection and haemostasis were performed using conventional material s ( Vicryl , stitches , V titanium hemostatic clips and monopolar or bipolar electrocautery ) ;  174 patients were included in a group in which the FOCUS was used ( F group ) . RESULTS Our data show that the FOCUS allows a one-third time-saving vs. classic haemostasis . Moreover , the use of the FOCUS would allow reduced traction and reduced manipulation of the thyroid during surgery . Our data demonstrate that the rate of complications in the Focus group might not be significantly reduced . In our series , we noticed that the quantitative acoustic assessment of voice quality show important alterations in several parameters ( Shim , Jitt , sPPQ , sAPQ studied with the Multi Dimensional Voice Program evaluation ) between the C group and F group . CONCLUSIONS The FOCUS Harmonic Scalpel reduces the operative time , post-operative blood loss and length of hospital stay in thyroidectomy . Besides , important vocal alterations after thyroidectomy seem more severe using the conventional technique instead of FOCUS BACKGROUND The Harmonic Focus is the last ultrasonic device design ed for thyroid surgery . The aim is to assess its efficacy and safety compared with traditional dissection in a prospect i ve r and omized trial of total thyroidectomy procedures . METHODS Total thyroidectomy was performed in 34 patients using the Harmonic Focus , and in 34 patients using the clamp- and -tie technique .  RESULTS In the Harmonic Focus group , relative reductions of 29 % and 46 % were observed in surgical time and blood loss , respectively . The number of intraoperative instrument exchanges also decreased by 70 % , and use of specific material s required to achieve hemostasis decreased significantly . Safety was found to be similar in both patient groups . CONCLUSIONS Our study showed beneficial effects of Harmonic Focus use in thyroid surgery . Further studies therefore are needed to evaluate cost in the light of savings made in surgical time , material s needed for hemostasis , and human re sources The aim of this study was to compare the results obtained using an electrothermal bipolar vessel sealing system ( Ligasure Precise ) , a harmonic curved shears ( Harmonic Focus ) and traditional technique in total thyroidectomy . We have enrolled 93 patients and assigned r and omly to three groups of 31 pt : groups L ( Ligasure Precise ) , F ( Harmonic Focus ) and C ( traditional thecnique ) .  Recorded data were demographics , preoperative serum calcium levels , operation time , length of hospital stay , weight of exported gl and and pathology , postoperative calcemia at one and two days and recurrent laryngeal nerve paralysis . The three groups did not present statistically significant differences in term of age , gender and pathology classification . No postoperative haemorrhages were observed . The overall incidence of hypocalcemia was 38.9 % ( 36 pt ) and the mean days of hospitalization were 2.3 days without statistically significant differences between the three groups . Only one patient ( group F ) presented temporary recurrent laryngeal nerve paralysis . Mean operation time ( minutes ) was significantly reduced by approximately 15 % in group F ( 62.7+/-14.1 ) compared with group C ( 72.7+/-13.6 ; Kruskal-Wallis test : p<0.05 ) . Both devices result ed safe and efficient . The only advantage observed was a significant reduction operation time when using Harmonic Foscus curved shears compared to the other techniques BACKGROUND The ultrasonic scalpel is a recently introduced device in head and neck surgery . Total thyroidectomy is the most common endocrine procedure performed by surgeons . METHODS This was an open , phase IV , multicenter , r and omized controlled trial ( RCT ) that compared the use of an ultrasonic scalpel with a conventional technique in patients who underwent total thyroidectomy . The outcomes were surgical complication rate , operative time , drainage volume , postoperative pain , and costs . RESULTS In all , 261 patients were included in 11 centers . There was a mean difference of 17 % of operative time in favor of the ultrasonic scalpel group . There were no differences in postoperative complications . There was a difference in costs of 14 % in favor of the ultrasonic scalpel group , but it was not statistically significant . CONCLUSIONS The use of an ultrasonic scalpel was as safe as that of the conventional technique and had the advantage of a shorter operative time and lower postoperative drainage . Costs were not different between groups Objectives Harmonic Scalpel ( HS ) and Maxium ( MAX ) are surgical shears that enable simultaneous vessel sealing and tissue coagulation . This study compares the outcome of  Total Thyroidectomy ( TT )  using Conventional Suture Ligation ( CSL ) technique versus ( vs ) two sutureless techniques ; H S and MAX techniques in terms of safety , operative time , blood drainage volume , hospital stay and surgical complications . Study design This is a prospect i ve observational cohort study . Setting This study was performed in AL-Karama Teaching Hospital/College of Medicine/University of Wasit/I 
    Output:
    
Total thyroidectomy using a harmonic scalpel is effective and safe compared to the conventional technique