New technique using an energy-based device versus conventional technique in open thyroidectomy

A Prospective, Randomized Study between the Small Jaw® and the Harmonic Focus® in Open Thyroidectomy

“…Previous studies comparing the usefulness of energy-based devices versus clamp-and-tie maneuvers in open thyroidectomy procedures have concluded that the energy-based devices allow effective curtailment of surgery time and safe tissue removal with no increase in postsurgical complications. [1][2][3][4] Many open thyroidectomy procedures now include energy-based devices: harmonic scalpels or bipolar vessel sealing systems.The Harmonic Focus Ò (HF; Ethicon Endo-Surgery, Inc, Seoul, Korea; Figure 1) and LigaSure Small Jaw Ò (LSJ; Covidien, Energy-Based Devices, Boulder, Colorado; Figure 2) are 2 brands of energy-based devices that are frequently used in thyroid surgery. There are previous studies comparing harmonic scalpels, bipolar vessel sealing systems, and conventional surgical methods, 5-7 but since the introduction of the LSJ in 2010, there have been few studies comparing the LSJ with the HF or with conventional surgical methods, 4,8 and to our knowledge, there is no…”

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

“…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).…”

“…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.…”

“…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.…”

“…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).…”