Energy Based Vessel Sealing Devices in Thyroid Surgery: A Systematic Review to Clarify the Relationship with Recurrent Laryngeal Nerve Injuries

Abstract

Background and objectives: The principal complications associated with thyroid surgery consist in postoperative recurrent laryngeal nerve (RLN) palsy, hypoparathyroidism, intra-operative and post-operative hemorrhage. In this paper, structured as a literature review, we describe the current knowledge and the technical improvements currently employed in the field of thyroid surgery, focusing on the contribution of energy based devices in relation with the reduction of the operating time and the odds of possible complication. Materials and methods: a relevant systematic literature search on Pubmed was carried out including works from 2004 through 2019, selecting studies providing information on the energy based devices employed in surgeries and statistic data concerning RNL (transient and permanent) injury and operative time. Results: Nineteen studies were reviewed, dealing with 4468 patients in total. The operative variables considered in this study are: employed device, number of patients, pathological conditions affecting the patients, surgical treatment, RNL injury percentage and the operating time, offering an insight on different patient conditions and their relative operative outcomes. A total of 1843 patients, accounting to the 41.2% of the total pool, underwent the traditional technique operation, while 2605 patients (58.3%) were treated employing the energy based devices techniques. Thyroidectomy performed by approaches different from traditional (for example robotic, MIVAT (Mini Invasive Video Assisted thyroidectomy)) were excluded from this study. Conclusions: The energy-based vessel sealing devices in study, represent a safe and efficient alternative to the traditional clamp-and-tie hand technique in the thyroidal surgery scenario, granting a reduction in operating time while not increasing RNL injury rates. According to this information, a preference for energy based devices techniques might be expressed, furthermore, a progressively higher usage rate for these devices is expected in the near future.

The new onset of GERD after sleeve gastrectomy: A systematic review

“…There is improvement in Gerd as assessed by the symptom questionnaires. The new onset of GERD detected on scintigraphy may not be pathological as there is a decrease in total acid production after surgery; however, it still remains an important issue and needs long-term follow-up [ [74] , [75] , [76] ].…”

Improving Voice Outcomes after Thyroid Surgery and Ultrasound-Guided Ablation Procedures

“…Today, hemostasis can be achieved in multiple ways: clamp-and-tie, electrocautery (monopoloar or bipolar), with hemostatic clips, and more advanced EBD that use thermal, ferromagnetic, or ultrasonic energy to ligate, seal and dissect tissue ( 36 ). Even though more advanced techniques with EBD have demonstrated reduced pain, wound drainage, decreased rates of neck hematoma and even hypocalcaemia ( 37 – 40 ), the results for EBD are inconsistent in terms of rates of RLN injury compared with conventional approaches ( 41 , 42 ). Several studies have demonstrated that traction and thermal injury are the first and second most common causes of iatrogenic RLN injury during thyroidectomy ( 39 , 43 , 44 ).…”

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

“…In the literature, several reports comparing the energy-based devices with the traditional technique exist. In most of these studies, Harmonic Focus and LigaSure Small Jaw (a device that works by means of advanced bipolar energy) [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ] were evaluated. Far fewer studies that compare the different devices with each other exist [ 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 ].…”