The aim of this study was to evaluate the potential advantages and the general operative cost of the Harmonic Scalpel (HS) in surgery for multinodular goiter (MNG). Methods: Patients undergoing total thyroidectomy (TT) for MNG were prospectively allocated in a conventional tie-and-clip (TC) group (n ϭ 50) and an HS group (n ϭ 50). All pre-and postoperative data were recorded. The economic evaluation was based on a microcost measurement and aimed to consider all the resources consumed for each

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... tient during the surgical procedure. To compare the results, we used the nonparametric unpaired two-tailed Mann-Whitney test. Results: There were 81 women and 19 men (mean age, 55 Ϯ 15 years). Mean preoperative TSH level was 1.2 (SD, 1.1) (TC) and 1.3 (SD, 2) (HS) (P ϭ NS). Mean body mass index was 24.72 (SD, 8) (TC) and 25.6 (SD, 8) (HS) (P ϭ NS). Four patients experienced a transient hypocalcemia (2 in each group). One patient had a postoperative hematoma requiring surgical evacuation (HS). One patient experienced a transient recurrent nerve palsy (TC). Mean length of surgery was 104 (SD, 32) (TC) and 84 minutes (SD, 17) (HS) (P ϭ .0001). Mean length of hospitalization was 2 days in both groups (SD, 1) (P ϭ NS). Mean operative cost per patient was 990 (SD, 191) in the TC group and 1,024 (SD, 143) in the HS group (P ϭ NS). Conclusion: Safety and efficiency of the HS is comparable to the tie-and-clip technique in thyroid surgery. The use of the HS in MNG surgery allows for a significant reduction in the length of the procedure with a comparable cost.