A comparison of the outcome using Ligasure™ small jaw and clamp-and-tie technique in thyroidectomy: a randomized single center study

Coiro, Saverio; Frattaroli, Fabrizio Maria; Lucia, F. De; Manna, Elena; Fabi, Fulvia; Frattaroli, Jacopo Maria; Pappalardo, G

doi:10.1007/s00423-014-1270-y

Cited by 37 publications

(42 citation statements)

References 20 publications

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“…When it was soaked by 50 % the means that it contains about 25 ml of blood and if totally soaked; 100% this means that it contains 75 ml of blood [16]. Many researchers reported significant reduction of intra-operative blood loss by the use of ligasure system in total thyroidectomy when compared with the conventional sutureligation technique [6,17,18,19] and our data came in agreement with those reported results. The ligasure vessel sealing system can apply control, sealing vessels up to 7 mm in diameter and facilitates surgery by achieving the efficient haemostasis of blood vessels encountered during dissection, and allowing the rapid and secure division of vascularised tissues, while minimizing thermal injury to adjacent tissues [20].…”

Section: Discussionsupporting

confidence: 83%

Use of Ligasure Sealing Versus Conventional Suture - Ligation in Total Thyroidectomy

AlJuraibi¹

2016

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Introduction:Effective vessel haemostasis can be achieved by suture knot tying technique or newer techniques of vessel haemostasis like ligasure as an alternative bipolar surgical diathermy system. Various diathermy techniques have been proposed to reduce intraoperative blood loss in surgery and the new electrothermal bipolar tissue sealing system (Ligasure) has been applied in various specialties of surgery. The objective of this randomized study was to compare the outcome of ligasure versus conventional clamping and tie in total thyroidectomy for benign thyroid diseases. Patients and Methods: A total of 200 patients diagnosed to have bilateral BMNG were subjected to primary total thyroidectomy and divided into two main groups Ligasure (L) and Suture-Ligation (SL). For detection of laryngeal nerves status, vocal cords were checked immediately postoperatively by laryngoscope and at the day 10 of postoperative period to assess the status of both laryngeal nerves. The function of the parathyroids was checked by detecting the serum calcium concentration and parathyroid hormone level. The following parameters were measured to compare the effect of ligasure versus conventional suture-ligation technique in decreasing the operative blood loss, operative time, securing laryngeal nerves and parathyroids, postoperative drainage and postoperative wound infection. Results: There was no statistical difference between the two groups regarding age, sex and body mass index and also there was no operative mortality. As regard the operative time, in ligasure group it was 115.54±15.35 minutes while in suture-ligation group was 127.1±7.95 minutes and intraoperative blood loss in group A was 62.06± 7.34 and in group B was 75.84± 9.21. Temporary RLN injury was detected in 3 patients (3%) in group A and in 5 patients in group B (5%). No permanent hypoparathyroidism was seen in group A patients but in one patient (1%) of group B, transient hypoparathyroidism occurred in 2 patients (2%) of both groups. The amount of fluid drained in group A was 54.16±9.21 and 66.28±8.99 in group B. Conclusion: The use of the Ligasure sealing system in total thyroidectomy is proved safe and effective in reducing the operative time, intraoperative blood loss together with reduction in postoperative fluid drainage. Owing to the ability to reduce energy spread profile, use of Ligasure sealing system is accompanied with better outcome regarding the function of laryngeal nerves and parathyroids.

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Section: Discussionsupporting

confidence: 83%

Use of Ligasure Sealing Versus Conventional Suture - Ligation in Total Thyroidectomy

AlJuraibi¹

2016

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“…Among them, 5 of total 7 researches compare LS Small Jaw with clamp-and-tie, and there is significant reduced operative time in LS Small Jaw group (MD = −17.49, 95% CI: −22.20 to 12.77, P < 0.00001). [10,11,13,15,16] The other 2 studies reported the similar significant reduced operative time when LS Small Jaw is compared with Harmonic Focus Scalpel (MD = −2.29, 95% CI: −3.19 to 1.39, P < 0.00001) (Fig. 2).…”

Section: Resultsmentioning

confidence: 77%

“…After screening the potential full texts of hit abstracts, 7 studies including a total of 813 patients who underwent thyroidectomy compared the surgical outcomes between LS Small Jaw and clamp-and-tie/Harmonic Focus Scalpel. [10–16] Among them, 5 studies (386 patients) compared LS Small Jaw and clamp-and-tie, [10,11,13,15,16] and the residual 2 studies (427 patients) compared LS Small Jaw and Harmonic Focus Scalpel for thyroidectomy. [12,14] The baseline characteristics of all studies are listed in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…It is not hard to randomly allocate thyroidectomy into LS Small Jaw or other instruments. So the included 4 of total 7 researches were prospective randomized studies, [10,11,13,14] and another 3 studies were 2 retrospective controlled studies [15,16] and 1 prospective nonrandomized study. [12] As for qualitative assessment, Table 2 showed the evaluation of each study followed by The Cochrane Collaboration's risk of bias tool and modified NOS.…”

Section: Resultsmentioning

confidence: 99%

“…4). [10,11,15,16] In the quantitative analysis of temporary RLN palsy, 6 studies reported available data, [10–12,14–16] and LS Small Jaw did not bring any significant benefits compared with whether clamp-and-tie (HR = 0.97, 95% CI: 0.41–2.28, P = 0.94) or Harmonic Focus Scalpel (HR = 0.73, 95% CI: 0.33–1.64, P = 0.45) (Fig. 5).…”

Section: Resultsmentioning

confidence: 99%

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A meta-analysis comparing the outcomes of LigaSure Small Jaw versus clamp-and-tie technique or Harmonic Focus Scalpel in thyroidectomy

Zhang

Yang

et al. 2017

Medicine

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Background:LigaSure (LS) Small Jaw is a surgical hemostasis equipment that is newly introduced in thyroid surgery. The objective of this study is to assess the short-term efficacy and safety outcomes of LS Small Jaw compared with clamp-and-tie technique or Harmonic Focus Scalpel in thyroidectomy.Methods:A literature search was performed in the PubMed and Embase databases (until June 12, 2016) that reported the comparisons between LS Small Jaw and other techniques in thyroidectomy. Quality assessments were performed according to The Cochrane Collaboration's risk of bias tool and a modification of the Newcastle-Ottawa Scale in randomized controlled trials (RCTs) and non-RCTs, respectively. All statistical analyses were conducted using RevMan 5.3.Results:Finally, 7 studies with 813 patients were included into the meta-analysis, and all included studies were comparable with moderate-to-high quality. There was significant reduced operative time in LS Small Jaw, compared with clamp-and-tie (mean difference [MD] = −17.49, 95% confidence interval [CI]: −22.20 to 12.77, P < 0.00001) or Harmonic Focus Scalpel (MD = −2.29, 95% CI: −3.19 to 1.39, P < 0.00001). Besides, other perioperative outcomes including intraoperative blood loss and postoperative blood loss favored LS Small Jaw compared with clamp-and-tie. In terms of complications, less-temporary hypocalcemia rate was observed in LS Small Jaw compared with clamp-and-tie (odds ratio [OR] = 0.49, 95% CI: 0.27–0.90, P = 0.02), although no significant difference was detected compared with Harmonic Focus Scalpel (OR = 0.47, 95% CI: 0.14–1.56, P = 0.22). Other complications such as length of hospital stay, permanent hypocalcemia, temporary or permanent recurrent laryngeal nerve palsy, and hematomas were not significant.Conclusion:In conclusion, LS Small Jaw is more favorable than clamp-and-tie technique or Harmonic Focus Scalpel in thyroidectomy.

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Randomized clinical trial of platysma muscle suture versus no suture for wound closure after thyroid surgery

Senne¹,

Zein²,

Falch³

et al. 2018

British Journal of Surgery

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Background: Suturing the platysma muscle during wound closure after thyroid surgery is frequently described in the literature. There is no prospective evidence to support its use or benefit. The aim of this study was to evaluate how a platysma muscle suture influences initial postoperative pain following thyroid surgery.Methods: Patients were assigned randomly to receive a platysma suture or no platysma suture in this prospective, patient-blinded trial. The duration of follow-up was 6 months. The primary endpoint was wound-specific pain 24 h after thyroid resection. Secondary endpoints were intraoperative and perioperative analgesia requirement, postoperative pain and complications until postoperative day 14, and Patient and Observer Scar Assessment Score (POSAS) 6 months after surgery.Results: Forty-one patients were randomized to each group. Visual analogue scale scores for wound-specific pain were lower in patients without a platysma suture 24 h after surgery (mean(s.d.) 3⋅15(1⋅46) versus 2⋅17(1⋅41) in groups with and without suture respectively; P = 0⋅002). There were no differences in the perioperative and postoperative need for analgesics, postoperative wound complications or cervical scar cosmesis 6 months after surgery (mean(s.d.) POSAS 23⋅99(9⋅53) versus 26⋅51(8⋅69); P = 0⋅148). Conclusion:Omitting the platysma muscle suture after thyroid surgery resulted in less wound-specific pain initially, with no difference in postoperative wound complications or cosmetic results. Registration number: NCT02951000 (http://www.clinicaltrials.gov).

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A comparison of the outcome using Ligasure™ small jaw and clamp-and-tie technique in thyroidectomy: a randomized single center study

Abstract: The employment of LSJ reduces in a statistically significant way both operative times and intraoperative blood losses. No significant differences were found as far as postoperative RLN paralysis and hypoparathyroidism.

Cited by 37 publications

References 20 publications

Use of Ligasure Sealing Versus Conventional Suture - Ligation in Total Thyroidectomy

Use of Ligasure Sealing Versus Conventional Suture - Ligation in Total Thyroidectomy

A meta-analysis comparing the outcomes of LigaSure Small Jaw versus clamp-and-tie technique or Harmonic Focus Scalpel in thyroidectomy

Randomized clinical trial of platysma muscle suture versus no suture for wound closure after thyroid surgery

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