Aim: Thyroidectomy is a surgical procedure that requires meticulous dissection, safe anatomical exposure 
and effective haemostasis. The aim of the present study is to compare the use of the harmonic scalpel with 
conventional haemostatic techniques in patients with benign thyroid enlargement undergoing total 
thyroidectomy 
Method: Consecutive patients treated for thyroid enlargement at our institution were evaluated for 
inclusion. Participants were randomly allocated to receive total thyroidectomy using harmonic scalpel (HS) 
or using ligature conventional thyroidectomy (CT), Study variables included operative time, length of 
incision, operative bleeding, postoperative drainage, hospital stay and complication. 
Results: one hundred and thirty patients with benign thyroid enlargement were randomized and completed 
the study. The mean incision length was 5.14±1.13 cm (4 -7 cm) in HS group and 8.78±1.4 cm (6-11 cm) in CT 
group p=0.04. Operative time was 50.27 ± 8.03 minutes for HS and 102.38 ± 14.63 minutes for CT (p=0.001). 
There was a significant difference in intraoperative bleeding and postoperative drainage between the two 
groups. Five patients (7.7%) in CT group and two patients (3.15%) in HS group experienced transient 
recurrent laryngeal nerve palsy (p= 0.24) .Two patients (3.15%) in HS group suffered from manifested 
hypocalcaemia and six patients (9.2%) in CT groups. 
Conclusion: HS is a safe, easier and effective alternative to knot tying technique for total thyroidectomy, 
allowing for a significant reduction of operative time, shorter incision, less intraoperative bleeding, less 
postoperative drainage without increasing complication rate.