Use of Ligasure in Thyroidectomy Procedures: Results of a Prospective Comparative Study
Department of General Surgery, Uludag University School of Medicine, 16059, Gorukle, Bursa, Turkey. World Journal of Surgery
(Impact Factor: 2.64).
07/2005; 29(6):771-4. DOI: 10.1007/s00268-005-7788-y
The thyroidectomy procedure requires many manupulations to achieve prompt hemostasis. This study assessed whether the outcomes of thyroidectomy using the Ligasure electrothermal vessel sealer were comparable with the conventional suture-ligation technique. We prospectively evaluated 58 consecutive patients who underwent thyroidectomy. Patients were allocated into two groups according to their preference. There were 30 patients in the Ligasure group and 28 patients in the conventional surgery group. Complications, operating time, and hospital stay were compared between the two groups and suture-ligations performed in the Ligasure group were recorded. The age, sex, and indications were similar in the two groups (p > 0.05). Complication rates and hospital stays did not show any difference according to the techniques used. Operating time was shorter in the hemithyroidectomy and total thyroidectomy patients of the Ligasure group (mean +/- SD: 77.38 +/- 13.71 vs. 99.80 +/- 12.53 minutes, p = 0.005; and 102.50 +/- 16.69 vs.128.89 +/- 19.74 minutes, p = 0.010). The mean +/- SD number of suture-ligations for each patient in the Ligasure group was 1.83 +/- 2.12. Thyroid surgery using the Ligasure is safe, and its complication rates are comparable to these found with the conventional surgical technique. Use of the Ligasure during hemithyroidectomy and total tyhroidectomy operations provides a significantly shorter operating time.
Available from: Thijs van Dalen
- "Although this absolute gain of approximately seven and a half minute does not appear to be clinically significant, the total operative time has to be taken into account. In their study, the reported operative time for a total (bilateral) thyroidectomy is extremely short and is not in line with other randomised or prospective studies, reporting a total operation time for a total thyroidectomy between 70-120 minutes [4,6,7]. Furthermore in both other trials haemostatic clips were used in both treatment arms too. "
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ABSTRACT: In thyroid surgery vessel division and haemostasis make up an important and time consuming part of the operation. While the presence of the recurrent laryngeal nerve limits the liberal use of diathermia, the many arterial and venous branches to and from the thyroid gland necessitates the use of numerous conventional suture ligatures.This study evaluates the effect of using a vessel sealing system on operation time during thyroid surgery.
A randomized clinical trial was performed between September 2005 and October 2008 in a teaching hospital. Forty patients undergoing total hemithyroidectomy participated in the trial. Twenty were randomized to the intraoperative use of the LigaSure Precise™ vessel sealing system, and twenty to the use of conventional suture ligatures.
The total median operation time was 10 minutes shorter in the LigaSure group (56 versus 66 minutes, P = 0.001). No significant differences in complications were noticed.
Using an electrothermal vessel sealing system during thyroid surgery is time saving.
This trial was registered in the international standard randomized controlled trials number register (ISRCTNR) under number ISRCTNR82389535.
Available from: Roberto Cirocchi
- "During the last ten years MIVAT (Minimally invasive video assisted throidectomy) was standardized by Miccoli in 1999, and various devices were introduced in order to do a safe section and haemostasis of thyroidal vessels (LigaSure and Ultrasonic dissector). The Ultracision dissector (UAS) (First generation "Harmonic scalpel"; Johnson & Johnson®) is a device that uses vibration at 55,5 KHz simultaneously cut and coagulate tissue. "
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ABSTRACT: We conducted a systematic review to evaluate the role of Ultrasonic dissector (UAS) versus conventional clamp and tie in thyroidectomy.
We searched for all published RCT in into electronic databases. To be included in the analysis, the studies had to compare thyroidectomy with UAS versus conventional vessel ligation and tight (conventional technique = CT). The following outcomes were used to compare the total thyroidectomy group with UAS versus CT group: operative duration, operative blood loss, overall drainage volume during the first 24 hours, transiet laryngeal nerve palsy, permanent laryngeal nerve palsy, transiet hypocalcaemia and permanent hypocalcaemia.
There are currently 7 RCT on this issue to compare thyroidectomy with UAS versus CT. From the analysis of these studies it was possible to confront 608 cases: 303 undergoing to thyroidectomy with UAS versus 305 that were treated with CT. Actually, it was shown a relevant advantage of cost-effectiveness in patients treated with UAS; there is a statistically significant reduction of the operative duration (weighted mean difference [WMD], -18.74 minutes; 95% confidence interval [CI], (-26.97 to -10.52 minutes) (P = 0.00001), intraoperative blood loss (WMD, -60.10 mL; 95% CI, -117.04 to 3.16 mL) (P = 0.04) and overall drainage volume (WMD, -35.30 mL; 95% CI, -49.24 to 21.36 mL) (P = 0.00001) in the patients underwent thyroidectomy with UAS. Although the analysis showed that the patients who were treated with USA presented more favourable results in incidence of post-operative complications (transient laryngeal nerve palsy: P = 0.11; permanent laryngeal nerve palsy: not estimable; transient hypocalcaemia: P = 0.24; permanent hypocalcaemia: P = 0.45), these data didn't present statistical relevance.
This meta-analysis shown a relevant advantage only in terms of cost-effectiveness in patients treated with UAS; it is subsequent to statistically significant reduction of operation duration, intraoperative blood loss and of overall drainage volume during the first 24 hours. Although the analysis showed that the patients who were treated with UAS presented more favourable results in incidence of post-operative complications (transiet laryngeal nerve palsy; transiet hypocalcaemia and permanent hypocalcaemia), these data didn't present statistical relevance.
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One of the keystones in surgery of the thyroid gland is accurate hemostasis. This can be achieved by conventional ligations or new instruments as harmonic scissors or bipolar devices. In the present study, we report our experience with a new bipolar thermofusion vessel sealing system (TVS) compared to conventional vessel ligation (CVL).
This prospective non-randomized study included 186 patients operated on by two surgeons between April and November 2007. Age, gender, preoperative diagnosis, type of surgery, operative time, and complications were prospectively collected. TVS was used in 93 patients (29 M, 64 F; mean age 50 ± 14 years, range 11–83) and CVL in 93 patients (27 M, 66 F; mean age 49 ± 14 years, range 16–82). Results and postoperative complications were registered.
Postoperative complications included two cases of transient hypocalcaemia in both groups 1 (TVS group) and 2 (CVL group) hemorrhages requiring reoperation (p = ns). No recurrent laryngeal nerve palsy was observed in both groups. A drain was used in 25 cases in the TVS group and in 47 patients in the CVL group (p < 0.008). Mean operative time for total thyroidectomy was significantly shorter in the TVS group (73 ± 18 min, range = 35–110) than in the CVL group (81 ± 20 min, range = 40–130; p < 0.01). No differences were found for lobectomies or subtotal thyroidectomies.
TVS is safe with a similar complication rate as CVL. Mean operative time for total thyroidectomy is shortened with TVS.
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