Safely Increasing the Efficiency of Thyroidectomy Using a New Bipolar Electrosealing Device (LigaSure™) versus Conventional Clamp-and-Tie Technique

Abstract

Operative time in thyroid surgery can be safely reduced through use of a new bipolar electro-sealing device (LigaSure). We evaluated consecutive patients undergoing thyroid surgery from January 2003 through January 2005 (n = 155). During the first half of the study, hemostasis was obtained using silk ties (conventional group, n = 70). During the second half of the study period, hemostasis was obtained with a bipolar electrosealing device (LigaSure group, n = 85). The mean operative time was 130 ± 37 minutes in the conventional group and 110 ± 33 minutes (P < 0.001) in the LigaSure group. EBL in the LigaSure group was statistically significantly less (43 ± 53 vs 33 ± 33 mL; P < 0.05). Postoperative calcium level was statistically significantly higher in the Liga-Sure group (8.2 ± 0.5 vs 8.4 ± 0.6 mg/dL, P < 0.05). Hospital length of stay (LOS) did not differ significantly. One patient in each group developed neck hematoma requiring reoperation. One permanent recurrent nerve injury occurred in the conventional group and one transient bilateral recurrent nerve injury occurred in the LigaSure group. The occurrence of symptomatic hypocalcemia was similar between the two groups. The training level of the surgical resident had no significant impact on the operative time, estimated blood loss (EBL), LOS, or complication rate. LigaSure bipolar electrosealer as the primary means of hemostasis during thyroidectomy significantly reduces mean operative times. Rates of operative complications were unchanged. LigaSure use in thyroid surgery can safely increase efficiency.

Bipolar Vessel Sealing System Versus Suture Ligation in Selective Neck Dissection

“…We did not find any statistically significant difference in terms of postoperative edema (p [ 0.05), postoperative complications, need for perioperative blood transfusions, or duration of hospital stay between the two groups. Most studies that have compared the hospitalization time reported no significant difference between the two groups, similar to our findings [14,16,17,21]. In one study, however, the postoperative hospital stay was significantly less for the patients in vessel sealer group than in conventional group (p \ 0.05) in thyroidectomy [13].…”

“…Various studies comparing the EBVS with clamp-and-tie technique have shown similar blood loss in both (p [ 0.05) [12][13][14][15]. In contrast, several other authors have reported significantly less blood loss for the EBVS compared to suture ligation [16][17][18]. This variation in findings is perhaps due to the fact that the gravimetric method of measurement of blood loss is a very crude method.…”

Safety of Same Day Discharge in Patients Undergoing Sutureless Thyroidectomy: A Comparison of Local and General Anesthesia

“…Specifically, there was no difference in major complications between the local and general anesthesia groups despite significantly larger average weights and longer length of stay in the general anesthesia group. Others have reported a decrease in hypocalcemia, reduction in scar size and operative time, or no differences in major complications (4,(18)(19)(20)(21)(22). Most importantly, hemostasis of the upper and lower pole vessels is particularly important in the prevention of postoperative bleeding and hematoma formation.…”

Radiofrequency dissection versus ‘knot tying’ in conventional total thyroidectomy

“…In addition to conventional ligatures, haemostasis can be achieved using clips, staples, and several types of energy-based tissue sealing and cautery devices (e.g. those that use monopolar and bipolar electrical currents, laser, ultrasonic waves and the harmonic scalpel) 1 – 19 . The conventional knot tying technique requires a large number of surgical ties and is therefore time-consuming.…”