Effectiveness of hemostatic agents in thyroid surgery for the prevention of postoperative bleeding

Abstract

Postoperative bleeding remains one of the most frequent, but rarely life-threatening complications in thyroid surgery. Although arterial bleeding is the main cause of postoperative hemorrhage, most often no actively bleeding vessel can be found during revision. Therefore, the coagulation technique for larger vessels may play a minor role, and hemostatic agents could be of higher importance. In this descriptive, retrospective study, data of 279 patients with thyroid surgery (total of 414 thyroid lobectomies) were collected. We reviewed the electronic medical record by analyzing the histological, operative, laboratory and discharge reports in regards to postoperative bleeding. Of the 414 operated thyroid lobes, 2.4% (n = 10) bled. 1.4% (n = 6) needed reoperation while the other 1.0% (n = 4) could be treated conservatively. Hemostatic patches were applied 286 (69.1%) times. Of the 128 (30.9%) patch-free operated sides, 4.7% (n = 6) suffered postoperative bleeding. Tachosil ® alone was used 211 (51.0%) times and bleeding occurred in 1.4% (n = 3). Without statistical significance (p = 0.08) the use of Tachosil ® seems to help preventing postoperative bleeding. The combination with other patches doesn't appear to be more efficient. Due to its endocrine function, the thyroid gland is a well perfused organ. For this reason, a good hemostasis during surgical procedures is of utmost importance. Postoperative bleeding remains one of the most frequent complications, and can cause airway compression and respiratory distress in severe cases. Moreover, intraoperative bleeding can obscure important structures like the parathyroid glands and the recurrent laryngeal nerve, complicating surgical dissection and increasing morbidity Aleksandar, et al. 1-3. The frequency of postoperative cervical hematoma (PCH) in thyroid surgery requiring reoperation ranges from 0 to 9.1% 4 , and it is the most common reason for return to the operating room 5. Many factors influence perioperative hemostasis. In the literature, several preoperative patient's risk factors are described, such as Grave's disease 6-9 , benign pathology 6,8,9 , the use of anticoagulation or antiplatelet medication while doing surgery 6,10 , an increased size of the pathology specimen 6 , an emergent admission 8 , presence of 2 or more comorbidities 8 , previous thyroid surgery 9 , age 65 years and older 7,11 , African-American race 7 and history of alcohol abuse 7. A BMI greater than 30 kg/m 2 11,12 and male sex 7,9,11 are also independent risk factors associated with PCH. Furthermore, postoperative hypertension increases the risk of postoperative bleeding 9,13. In the past century, the only instruments at a surgeon's disposal to obliterate vessels were needle and thread in order to create a ligation. Nowadays, the industry provides a variety of devices to seal and cut vessels, such as metal clips, bipolar coagulation forceps (e.g. BiClamp ®) and ultrasound scissors. The type of sealing technique doesn't seem to affect the risk of postoperative bleeding. Alesina et al. and...

A systematic review and meta-analysis comparing tumor progression and complications between radiofrequency ablation and thyroidectomy for papillary thyroid carcinoma

“…Thyroidectomy is inevitably accompanied by bleeding and scarring, but there are advantages to RFA in terms of post-operative fever and nerve damage. Post-operative bleeding remains one of the most customary and fatal complications in thyroid surgery ( 55 , 56 ). Furthermore, nerve palsy (recurrent laryngeal nerve), hypothyroidism, and hypoparathyroidism are the most common surgical complications of thyroidectomy ( 57 – 59 ).…”

Novel Product for the Management of Coronary Ruptures Happening during Percutaneous Coronary Interventions

“…This product is routinely used by ENT surgeons for hemostatic purposes [ 7 ]. It has also been used recently for endovascular hemostasis and controlling bleeding in thyroid surgeries [ 8 , 9 ].…”

Efficacy of four different hemostatic agents in thyroid surgery in reducing the amount of post-operative fluid collection

“…The thyroid gland is a well perfused organ, there for a meticulous hemostasis during surgical procedures is essential [ 1 ]. To date, post-thyroidectomy hemorrhage admittedly counts as a rare but nonetheless sudden, unpredictable and potentially life-threatening event [ 2 – 5 ].…”

“…Over the last decades numerous technical devices have been developed to improve hemostasis in thyroid surgery such as, suture ligatures, vessel ligating clips, electrocoagulation by mono- or bipolar instruments and several topical hemostatic agents (HA) [ 9 ]. HA are divided into two groups: biologically active and physically active [ 1 ]. So far, the use of HA in thyroid surgery has been widely reported in the literature [ 10 ].…”