A Comparison of Two Methods of Hemostasis in Thyroidectomy

Abstract

Safe thyroid surgery requires meticulous hemostasis. The objective of the current study is to compare the effectiveness and safety of ultrasonic dissection (UD) and electronic vessel sealing (EVS) in patients undergoing thyroidectomy. A retrospective analysis of a prospectively maintained database was performed. Between January 1, 2007 and January 25, 2008, hemostasis was achieved using EVS (LigaSure Precise, Valleylab, Boulder, CO). Since January 25, 2008, hemostasis has been achieved using UD (Harmonic Focus, Ethicon Endo-Surgery, Cincinnati, OH). Operative time, estimated blood loss, gland weight, and postoperative complications were compared. Differences were analyzed using unpaired t test and Chi square with significance assigned P < 0.05. Seventy-four patients underwent total thyroidectomy (EVS n = 59, UD n = 15). Operative time (EVS 115.0 ± 38.3 min, UD 88.0 ± 14.0 min, P = 0.012) was significantly decreased in the UD group compared with the EVS group. There were no significant differences in mean age (EVS 50.4 ± 13.9 years, UD 49.1 ± 15.6 years), gender distribution (EVS 78% female, UD 87% female), estimated blood loss (EVS 49.4 ± 44.7 mL, UD 47.0 ± 70.4 mL), and gland weight (EVS 67.4 ± 66.4 gm, UD 41.3 ± 26.6 gm). Analysis of complications, including hematoma, hypocalcemia, and recurrent laryngeal nerve palsy showed no significant difference. Based on the current analysis, ultrasonic dissection is a safe method of hemostasis for thyroid surgery. Its use decreases operative time when compared with electronic vessel sealing.

Haemostasis in Thyroid Surgery: Collagen-Fibrinogen-Thrombin Patch versus Cellulose Gauze—Our Experience

“…The use of instruments as the harmonic scalpel and radiofrequency or thermal devices also improves vessel sealing and several studies confirm their effectiveness to prevent hemorrhagic events [ 7 – 9 ].…”

Blood transfusion, antibiotics use, and surgery outcome in thyroid surgery: Experience from a suburban center in Nigeria

“…The second patient had 1 unit transfusion during surgery for a giant multinodular goiter that weighed 845 g. Significant hemorrhage is a well-documented complication following thyroid re-operation, particularly for malignant goiter and in giant goiters. [12] Because of the high morbidity following surgery for recurrent malignant goiter, alternative treatment such as radioactive iodine is a preferred treatment in such patient where it is available. [13] One patient who had recurrent goiter was justifiably transfused with 2 units of blood, highlighting the need for selective cross-matching of blood for "high risk" thyroid patients.…”

The Efficacy Of Energy Based Vessel Sealer Devices During Total Thyroidectomy: A Comparative Single Institution Study

“…The efficacy of HS and LS has been indicated in various studies also (17)(18)(19)(20). McNally et al (21) in 2009 have reported that there were no significant difference in terms of adverse effects among the two energy devices; however they have found that severe asymptomatic hypocalcemia had been present in 6.7% of the cases being the most frequent complication. In addition, another study published in 2011 reported that there were no significant difference among the two devices in terms of transient dysphonia and hypocalcemia, hematoma and persistent recurrent nerve palsy in total thyroidectomy patients (1).…”