Sutureless thyroidectomy: surgical technique

Abstract

The technique of thyroid surgery has continued to evolve over the last 200 years. Sutureless thyroidectomy is one of the recent developments in surgical technique and is made possible by the use of vessel sealing devices. The most frequently used devices include a bipolar coagulation device (Ligasure Precise) and ultrasonic dissecting shears (Harmonic Scalpel FOCUS). The use of this technology is safe with minimal morbidity and has been shown in numerous studies to significantly decrease operative time. Over 3000 thyroid and parathyroid procedures, both open and minimally invasive, have been performed with vessel sealing devices within the University of Sydney Endocrine Surgery Unit since the technology was introduced in 2005. This manuscript discusses the technique of sutureless thyroidectomy focusing on points of difference in comparison with conventional thyroidectomy using ligatures or clips.

Which Hemostatic Device in Thyroid Surgery? A Network Meta-Analysis of Surgical Technologies

“…When ultrasonic coagulation and Ligasure were compared against each other with regard to operative time (both directly and indirectly), there was a trend favoring ultrasonic coagulation though the results were not shown to be statistically significant. The faster trend associated with ultrasonic coagulation compared with Ligasure can be explained by the fact that ultrasonic coagulation allows simultaneous sealing and division of vessels, while Ligasure only seals vessels that have to be subsequently cut with scissors after withdrawal of the device (20,63). This adds to the operative time and accounts for Ligasure being slower than ultrasonic coagulation.…”

Infrared laser thermal fusion of blood vessels: preliminaryex vivotissue studies

“…Some RF-based devices provide electrical current to the vessel followed by an actuated mechanical knife which separates the coagulum into two sealed segments. These devices expedite normally labor-intensive surgical procedures such as lobectomy, 1,2 nephrectomy, 3 gastric bypass, 4-6 splenectomy, 7,8 thyroidectomy, [9][10][11][12][13][14] hysterectomy, 15 and colectomy. [16][17][18][19] However, both electrosurgical and ultrasonic devices have limitations, including the potential for undesirable charring and unnecessarily large collateral thermal damage zones.…”

Thermal sealing systems with and without tissue divider for total thyroidectomy

“…Patients were selected for each group on the basis of device availability over a 2‐year period. Total thyroidectomy was performed in a standardized way which has been previously described . Serum parathyroid hormone levels were measured at 1–4 h following surgery and corrected calcium levels obtained routinely at 24 h, 2 weeks and 3 months following surgery.…”

“…Total thyroidectomy was performed in a standardized way which has been previously described. 9 Serum parathyroid hormone levels were measured at 1-4 h following surgery and corrected calcium levels obtained routinely at 24 h, 2 weeks and 3 months following surgery. Patients were discharged with oral calcium supplementation that was reduced according to an established protocol.…”