Comparing LigasureTM Exact dissector with other energy devices in total thyroidectomy: a pilot study

Abstract

Background: Hemostasis is fundamental in thyroid surgery. The aim of this randomized active comparator-controlled study was to compare the effectiveness of Ligasure TM Exact to previously existing sealing devices in patients undergoing thyroidectomy.Methods: A total of 180 patients were randomly allocated into 4 groups according to the hemostatic device used: Focus Harmonic Scalpel ® (FHS), Ligasure TM Small Jaw (LSJ), Thunderbeat ® (TB), and Ligasure TM Exact (LE). We recorded epidemiologic and biochemical data, operative difficulty, postoperative vocal alteration and pain, complications, operating time, grams of gland excised per minute, and hospitalization.Results: Differences (P<0.001) were observed concerning duration of surgery, operative difficulty and quantity of gland removed per minute. Concerning duration of surgery it is shorter for LE followed by TB and then by both FHS and LSJ. Concerning the quantity of thyroid removed per minute LE leads, followed by FHS and TB. The least amount of gland removed per minute is by LSJ. Finally, operative difficulty was less for LE, while it was equal for all other three devices.Conclusions: Energy devices are now frequently used in thyroidectomy. Comparing these devices seems to qualify them as equal concerning post-operative complications, hemostasis, and acute inflammatory reaction.However, Ligasure TM Exact Dissector seems to have better results concerning duration of surgery, quantity of thyroid tissue removed per minute and intraoperative difficulty.

The Use of Harmonic Focus and Thunderbeat Open Fine Jaw in Thyroid Surgery: Experience of a High-Volume Center

“…Ultimately, as regards the economic aspect, the gain in time leads to a decrease in the overall costs, which justifies the cost of the devices. Shorter operative times in thyroidectomies performed with TB compared with those with HF in our experience and in those of Back et al and Papavramidis et al [ 32 , 34 , 35 ], in our opinion, are due to a greater speed of TB in coagulation and cutting of tissues, probably resulting from the simultaneous use of two forms of energy.…”

“…As regards the other four clinical studies in which TB was considered, in all of these, no statistically significant difference was found in terms of complications between HF and TB [ 33 , 34 , 35 , 36 ]. However, in this regard, it is important to underline that Back et al [ 34 ] reported a higher rate of transient recurrent laryngeal nerve injury in patients operated on with TB although the difference was not statistically significant (probably due to the limited size of their sample).…”

“…About operative times, only Back et al and Papavramidis et al described shorter operations in patients operated on with TB than in those with HF [ 34 , 35 ].…”

“…Far fewer studies that compare the different devices with each other exist [ 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 ]. Moreover, currently, about the use of Thunderbeat Open Fine Jaw in thyroid surgery, to our knowledge, in the literature, there are only five other clinical studies (in this field of surgery, other investigations involving this device were carried out on porcine models) [ 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ].…”

Real-time intraoperative near-infrared autofluorescence imaging to locate the parathyroid glands: A preliminary report

“…The identification and location of PGs is a wellknown challenge of thyroid or parathyroid surgery (14). Accidental injury or resection may lead to hypoparathyroidism, which means temporary or permanent hypocalcemia and other accompanying symptoms (15).…”