Prospective Randomized Trial of Ligasure Versus Harmonic Hemostasis Technique in Thyroidectomy
Endocrine Oncology Section, Surgery Branch, National Cancer Institute, Bethesda, MD, USA. Annals of Surgical Oncology
(Impact Factor: 3.93).
11/2010; 18(4):1023-7. DOI: 10.1245/s10434-010-1251-5
Two surgical devices have become popular in thyroid surgery: a bipolar energy sealing system (B) and ultrasonic coagulation (UC). Retrospective and prospective studies have demonstrated that the use of these surgical devices for thyroidectomy compared with conventional thyroidectomy (clamp-and-tie) techniques reduces operative time and cost. We conducted a prospective randomized clinical trial to determine if there is any difference in operative time and cost between B and UC.
A single-blinded prospective randomized controlled trial was conducted at a tertiary referral center. A total of 90 patients who required a thyroidectomy for thyroid cancer, thyroid nodules, or hyperthyroidism were randomized to either B or UC during thyroidectomy. The operative time and cost of thyroidectomy were compared between the two groups.
There was no statistically significant difference in patient age, gender, body mass index, indication for thyroidectomy and thyroid gland weight between the two groups. There was no statistically significant difference in operating room cost or total cost for thyroidectomy between the B and UC groups. There was also no statistically significant difference in the operative time between the B and UC groups (187.6 vs. 184.2 min, P = 0.48) or in postoperative complication rates. The only statistically significant difference in total cost was between surgeons independent of the device used (P < 0.01).
In thyroid surgery, total cost and operative time were similar between the two surgical devices used.
Available from: Marco Cicciù
- "Others underlined the usefulness of the sentinel node biopsy to better assess the lateral neck compartment status for the purpose of detecting the occult lesions . Recently, new surgical techniques for haemostasis and use of nerve-sparing devices have been introduced to reduce complications arising from monopolar diathermy thermal injury  . "
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ABSTRACT: Introduction: Backgrounds of this study were to examine and analyse the relationship among the number of lymph nodes with metastases harvested in central and lateral compartments, the characteristics of tumours and patients, and the recurrences rate. Methods: A retrospective review of 118 patients treated for a papillary thyroid cancer and underwent to neck dissection, including in all cases both central and lateral compartment, was realised. A quantitative analysis, on this homogeneous cohort of patients, was performed to hypothesize the minimum number of cervical lymph nodes to be necessarily excised in order to obtain an adequate management of these patients. Results: The mean follow-up time was 75.9 months. Five-year overall survival was 96.6%. The correlation among the metastatic lymph node number of the ipsilateral central compartment, isolated or pooled with those of the ipsilateral lateral compartment, age of patient and tumour size revealed a statistical significance (P=0.01); both parameters, tumour size and age, may be considered as dependent predictor variables. Conclusion: We suppose, notwithstanding the limited number of patients, that the number of lymph nodes harvested to achieve an optimal cervical dissection may be superior to 8 and 11 in central and lateral compartments, and 6 and 10 in contralateral ones, respectively. Moreover we recommend the bilateral dissection of central nodes compartment in presence of tumour localised in the isthmus.
Available from: Kathrin Grummich
- "31 vs. 31 vs. 31 51 74 B Total Rahbari 2011  45 vs. 45 47 80 B and M Total and partial+CND Dionigi 2012  "
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ABSTRACT: Energized vessel-sealing systems have been proposed to save operation time and reduce post-operative complications. The aim of the present systematic review was to compare operation time and postoperative morbidity for ultrasonic and electrothermal bipolar-activated devices with conventional hemostasis techniques and with each other in open thyroidectomy.
A systematic literature search (MEDLINE, Cochrane Library, EMBASE and ISI Web of Science) was performed to identify randomised controlled trials (RCTs) comparing conventional hemostasis techniques, ultrasonic devices (Harmonic® scalpel) and/or electrothermal bipolar-activated vessel sealing systems (Ligasure®) during open thyroidectomy. For the primary endpoint (operation time), a network meta-analysis with Bayesian random effects model was performed. Pairwise meta-analyses with random effects were calculated for primary and secondary endpoints.
One hundred sixteen publications were evaluated for eligibility; 35 RCTs (4,061 patients) were included. There was considerable methodological and clinical heterogeneity of included trials. The Harmonic scalpel significantly reduced operation time compared with conventional techniques (22.26 min, 22.7 min in the inconsistency model). The use of Ligasure significantly reduced operation time in total thyroidectomy (13.84 min in the consistency model, 12.18 min in the inconsistency model). In direct comparison, operations with the Harmonic scalpel were faster than with Ligasure (8.42 min in the consistency model, 2.45 min in the inconsistency model). The rates of recurrent nerve palsy and postoperative hypocalcaemia did not significantly differ in the intervention groups.
This meta-analysis shows superiority of ultrasonic devices in terms of operation time compared with conventional hemostasis techniques in thyroid surgery, with no detriment to safety outcomes.
Available from: sciencedirect.com
- "According to these three meta-analyses, the Ligasure ® device decreases postoperative pain, but without decreasing hypocalcaemia or blood loss . Two prospective, randomized studies compared the two technologies  . Pons et al. demonstrated a significant 8-minute reduction of operating time with the Harmonic ® device compared to the Ligasure device (P = 0.04). "
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