Total thyroidectomy: conventional suture ligation technique versus sutureless techniques

Abstract

Background: Since the introduction of successful thyroidectomy no change occurred in the technique but with the innovation of sutureless surgery, sutureless thyroidectomy becomes a competitor for the conventional technique. In this study we tried to analyze the outcomes of each.Methods: This was a prospective cross armed uncontrolled randomized study included 65 patients suffering from non-malignant goiter who underwent total thyroidectomy, admitted to Sohag University Hospital from September 2017 to October 2018. Patients were randomly allocated into two groups; Group (S) managed with sutureless thyroidectomy, and Group (C) managed with conventional knot tying technique. The data of the patients were gathered and analyzed considering the operative and post-operative outcomes. All patients were followed-up for 6 -12 months.Results: We found a significantly shorter operative time (p=0.001), also the amount of intra-operative blood loss was highly significant less in Group S (p=0.001). There was higher incidence of post-operative pain in Group C (p<0.001), post-operative drainage volume was highly significantly less in Group S (p=0.001). Regarding post-operative complications; the incidence of recurrent laryngeal nerve paralysis (RLNP) was insignificant between both groups (p=0.38), in the same time the incidence post-operative transient hypocalcaemia was significantly more in Group C (P=0.025). The overall post-operative complication rate was significantly more in Group C (p=0.002). The duration of hospital stay was highly significant shorter in Group S (p=0.0001).Conclusions: The use of Harmonic FOCUS® is beneficial for both patient and surgeon; it is efficient and a trustable safe substitute to the conventional knot tying technique.

A comparative study between harmonic scalpel hemostasis and conventional hemostasis in total thyroidectomy

“…They also stated that the use of Harmonic FOCUS® significantly decreased the operative time compared with conventional knot tying technique in a matter of 50% less. 12 Contin et al also reported the same results. 13 And with all authors, the difference was statistically significant.…”

“…11 Also, Ali et al reported that the post-operative drainage volume (mean±SD) was 19.30±4.442 ml for the sutureless group and was 47.49±12.125 ml for the conventional group. 12 Al-Dhahiry and Hameed found in their study that using harmonic scalpel for total thyroidectomy was associated with less blood loss, operative time, and postoperative drainage volume. Also, Cheng et al in their systemic review and meta-analysis of using harmonic scalpel in thyroidectomy in comparison with the conventional technique, showed that ultrasonic harmonic scalpel decreases the intraoperative blood loss by 45 ml and drainage volume by 29 ml and reduces the operative time by 29 min.…”

“…11 Also, Ali et al reported that intraoperative blood loss (Mean±SD) was 33.07±5.753 (ml) for the sutureless group and was 75.09±15.417 (ml) for the conventional group. 12 Regmi et al showed that thyroidectomy by ultrasonic technique resulted in less intraoperative blood loss by 16 ml than in conventional thyroidectomy. 26 Rienzo et al showed in their series that intraoperative blood loss was comparable when they used a harmonic scalpel and Liga Sure vessel sealing device and significantly less than in the conventional clamping and knot-tying technique.…”

“…11 Ali et al in his study stated that the mean duration of hospital stay was shorter in Group S (sutureless) (1.97±0.183 days) than Group C (conventional) (1.97±0.183 days); this difference was highly significant. 12…”

Comparison of Complications of Harmonic Scalpel Versus Conventional Homeostasis in Patients Undergoing Near-Total Thyroidectomy at a Tertiary Care Hospital

“…So according Mohamed et al 13 , the sutureless group's operating time was 66 minutes, although the conventional group's operating time was 97 minutes. Moreover, as per Ali et al 14, the sutureless group's operating time (min) (mean + SD) was 55.40+7.894 minutes, compared to 108.14+11.186 minutes for the conventional group. Contin et al 15 observed the similar result.…”