Use of the electrothermal vessel sealing system versus standard vessel ligation in thyroidectomy

OBJECTIVE: The electrothermal vessel sealing system (LigaSure) facilitates operative haemostasis by fusing blood vessel walls to form a collagen seal. The LigaSure is currently used in a variety of gastrointestinal, gynaecological and urological operations. We report our experience with LigaSure for thyroidectomy to test the hypothesis that it reduces operating time without increasing complications compared with standard vessel ligation. METHODS: This non-randomized, retrospective review included 234 consecutive patients who underwent thyroidectomy by one surgeon. Standard vessel ligation was used in 99 patients between 1997 and 2000, and the LigaSure was used in 135 patients between 2001 and 2003. The following data were collected: patient demographics, thyroid pathology, type of operation (total thyroidectomy vs lobectomy), operating time, complications (transient or permanent hypocalcaemia, 相似文献   

LigaSure versus clamp-and-tie thyroidectomy for benign nodular disease

BACKGROUND: LigaSure is an alternative bipolar diathermy system (BDS) combining vessel sealing with reduced thermal spread, which has been successfully used in many abdominal operations; however, there is a little experience in open thyroidectomy. This study compares the efficacy and the advantages of the LigaSure BDS when used for total thyroidectomy for benign thyroid disease with the conventional clamp-and-tie technique. METHODS: Between May 1998 and October 2002, 517 patients underwent total thyroidectomy for benign thyroid multinodular goiter. Among them, from May 1998 until May 2000, 247 patients (group I) were operated on with the conventional clamp-and-tie technique, whereas from May 2000 until October 2003, 270 patients (group II) underwent total thyroidectomy for benign multinodular goiter with LigaSure BDS through a 4-cm transverse suprasternal incision. Demographics, pathologic characteristics, gland mass, operative time, blood loss, and complications were assessed. RESULTS: There were no intraoperative complications. Thyroid mass was similar in both groups, but the operative time was shorter in group II than in group I (mean +/- standard deviation, 71 +/- 14 minutes vs 86 +/- 22 minutes; p < .01). Intraoperative total blood loss was similar between the two groups, but postoperative drain volume was less in group II than in group I (21 +/- 15 mL; p < .01). Major post-thyroidectomy complications (ie, laryngeal nerve palsy, hematoma, and hypocalcemia) occurred less frequently in the LigaSure group than in the clamp-and-tie group (0.7%, 0.4%, 1.1% vs 4%, 2%, 4.8%, respectively; p < .05). The mean +/- standard deviation postoperative hospital stay was significantly less for the patients in group II than for those in group I (2.3 +/- 1.7 days vs 2.8 +/- 1.3 days; p < .05). CONCLUSIONS: The use of the LigaSure vessel sealer for thyroid surgery is an effective and safe alternative that reduces the overall operative time and could be successfully applied through a narrow surgical incision.     

Use of BiClamp Decreased the Severity of Hypocalcemia after Total Thyroidectomy Compared with LigaSure: A Prospective Study

BACKGROUND: Postoperative hypocalcemia is the most common complication after thyroidectomy. New surgical devices have been propose to achieve vessel sealing and hemostasis. However, the risk of parathyroid glands damage has not been fully elucidated. This prospective study was designed to evaluate the severity of hypocalcemia after total thyroidectomy by using two different sealing devices. METHODS: Between January 2005 and December 2006, 86 patients underwent total thyroidectomy by using BiClamp((R)) (n = 46) or LigaSure((R)) (n = 40) devices in our institution. The severity of postoperative hypocalcemia was analyzed. RESULTS: No mortality or recurrent laryngeal nerve palsy was observed. Patients characteristics were similar in both groups. The mean operation time was significantly shorter in the BiClamp group (142 +/- 35 minutes versus 170 +/- 57 minutes, P = 0.023). Eleven patients had symptomatic hypocalcemia. Hypocalcemia (< 2 mmol/l) at postoperative day 1 was more frequent in the LigaSure group than in the BiClamp group (P = 0.034). Significantly more patients in the LigaSure group required oral calcium supplementation than in the BiClamp group (67.5% versus 34.7% respectively; P = 0.002). CONCLUSION: The present prospective study suggests that total thyroidectomy can be performed safely with both surgical devices. However, BiClamp reduced the operative time and the severity of postoperative hypocalcemia.     

LigaSure in total thyroidectomy

PURPOSE: LigaSure is a bipolar diathermy system, which achieves vessel sealing with reduced thermal spread. The device has been used successfully in abdominal operations and because of its features, it has been applied recently in thyroid surgery to minimize the risk of complications such as laryngeal nerve palsy and hypocalcemia, and also to reduce the operating time. METHODS: Between June and December 2005, we performed total thyroidectomy for various disorders in 105 patients. We used the LigaSure diathermy system in 53 patients and traditional hemostatic procedures in the other 52. We evaluated the demographic features, histopathological diagnosis, operating times, and relevant postoperative complications. RESULTS: The two study groups had similar demographic and histopathological features. The mean operating time +/- SD was not significantly shorter in the LigaSure group than in the traditional group (104 +/- 12.7 vs 110 +/- 15.6 min). None of the patients in either group suffered hemorrhage, definitive hypocalcemia, or definitive laryngeal nerve palsy. Transient hypocalcemia and transient laryngeal nerve palsy developed in 7.54% and in 1.88%, respectively, of the patients in the LigaSure group, and in 7.69% and 1.92%, respectively, of the patients in the traditional group; these differences were not significant. CONCLUSIONS: LigaSure is a safe and effective method of hemostasis control, but it did not reduce the incidence of complications or operating times compared with traditional hemostatic procedures; moreover, the operative costs were higher.     

Use of a diathermy system in thyroid surgery

HYPOTHESIS: New hemostatic methods have been widely used in open and laparoscopic surgery. The LigaSure Precise diathermy system (Valleylab, Boulder, Colo) has been recently used in thyroid surgery. We hypothesized that its use could lead to reduced operative time and fewer complications compared with conventional knot tying in total or near-total thyroidectomy. DESIGN: Prospective case-controlled study. SETTING: Tertiary care private hospital. PATIENTS: Eighty patients underwent total or near-total thyroidectomy by 1 surgeon. INTERVENTIONS: Forty patients underwent thyroidectomy with the conventional knot tying technique and 40 patients with the LigaSure diathermy system. MAIN OUTCOME MEASURES: Demographics, histopathological diagnosis, operative time, intraoperative blood loss, complications, and cost, using chi2 test and Wilcoxon rank sum test. RESULTS: The study groups had similar demographic and histopathological characteristics. The mean +/- SD operative time was nonsignificantly reduced in the LigaSure group compared with the conventional knot tying group (84 +/- 6 vs 89 +/- 7 minutes, P = .60). The mean +/- SD intraoperative blood loss was less for the LigaSure group (30 +/- 5 vs 35 +/- 8 mL, P = .36). There was 1 case of transient recurrent laryngeal nerve palsy in the LigaSure group. One patient from this group and 2 patients from the other group exhibited transient hypocalcemia; permanent postoperative hypocalcemia was not encountered in either group. The cost of the LigaSure diathermy system was significantly greater than that of conventional knot tying. CONCLUSION: Use of the LigaSure in thyroid surgery did not significantly reduce operative time, blood loss, or complication rates compared with conventional knot tying, but it increased operative cost.     

Early (1 hour) post-operative parathyroid hormone (PTH) measurement predicts hypocalcaemia after thyroidectomy: a prospective case-control single-institution study

The aim of the study was to evaluate the efficacy of parathyroid hormone 1-hour assay for the early prediction of hypoparathyroidism after thyroidectomy. Candidates for total, subtotal, completion thyroidectomy or lobectomy were entered into the study. Pre- and postoperative calcium and parathyroid hormone (1 hour and postoperative day 1 after thyroidectomy) levels and clinical hypocalcaemia were recorded. Patients were divided into 3 groups and 2 subgroups: 1. patients who underwent lobectomy (control group); 2. patients who underwent total thyroidectomy with postoperative hypocalcaemia (2A: asymptomatic patients, 2B: symptomatic patients); 3. asymptomatic patients with normal calcium levels after total thyroidectomy. Of 119 patients, 109 underwent total thyroidectomy and 10 lobectomy. Of the 109 patients submitted to total thyroidectomy, 35 (32.11%) developed postoperative transient hypocalcaemia. Twenty-one patients (19.27%) were asymptomatic and 14 (12.84%) were symptomatic. Parathyroid hormone levels decreased after 1 hour in group 3 (32.98 pg/dl), 2A (9.84 pg/dl) and 2B (7.46 pg/dl). There was no significant difference in parathyroid hormone levels at 1 hour between group 2A and 2B (p = 0.06), but were significantly lower compared to groups 3 and 1 (p < 0.05). Parathyroid hormone levels at 1 hour after total thyroidectomy is a good predictor of early hypocalcaemia. It might be more useful than serum calcium monitoring for the early identification of patients requiring postoperative calcium supplementation.     

Safely increasing the efficiency of thyroidectomy using a new bipolar electrosealing device (LigaSure) versus conventional clamp-and-tie technique

Operative time in thyroid surgery can be safely reduced through use of a new bipolar electrosealing 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 LigaSure 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.     

Serum intact parathyroid hormone as a predictor of hypocalcaemia after total thyroidectomy

BACKGROUND: Hypocalcaemia from hypoparathyroidism is a complication of total thyroidectomy. The aim of the present study was to determine whether an early postoperative level of serum parathyroid hormone (PTH) after total thyroidectomy predicts the development of significant hypocalcaemia and the need for treatment. METHODS: Patients undergoing total thyroidectomy had their serum level of intact PTH checked 1 h after removal of the thyroid gland. Serum calcium level was checked on the following morning. Oral calcium and/or calcitriol was commenced if the patient developed hypocalcaemic symptoms, or if the corrected serum calcium level was <2.0 mmol/L. RESULTS: Seventy-nine patients were included in the present study. Thirteen patients had symptoms of hypocalcaemia on postoperative days 1 or 2 and 66 patients remained asymptomatic. The postoperative intact PTH, day 1 calcium and day 2 calcium was 0.32 +/- 0.60 pmol/L, 2.01 +/- 0.11 mmol/L, and 2.02 +/- 0.16 mmol/L, respectively, for the symptomatic group and 1.98 +/- 1.25, 2.21 +/- 0.13, and 2.19 +/- 0.14, respectively, for the asymptomatic group. Calcium support was given to 25 patients, of whom 14 also required calcitriol. CONCLUSION: Serum PTH 1-h after total thyroidectomy is a reliable predictor of hypocalcaemia and can allow safe early discharge of patients from hospital.     

LigaSure和超声刀在Miccoli手术中的应用研究

目的 比较LigaSure血管闭合系统与超声刀在Miccoli手术中应用的手术时间和并发症.方法 回顾性分析上海交通大学附属第六人民医院普外科2007年1月至2011年12月期间684例行Miccoli术式患者的临床资料,其中应用LigaSure血管闭合系统者335例,应用超声刀完成手术者349例.对其平均手术时间及术后常见并发症(切口内血肿、一过性声音嘶哑、永久性喉返神经麻痹及低钙血症)进行对比.结果 所有684例患者中,有263例行甲状腺全切除术,421例行甲状腺腺叶切除术.使用超声刀者手术时间略短于使用LigaSure血管闭合系统,但二者比较差异无统计学意义(P＞0.05);二者的术后常见并发症比较差异亦无统计学意义(P＞0.05).结论 LigaSure血管闭合系统和超声刀设备应用于甲状腺手术均是安全、可靠的,术者可根据手术习惯及医院配备选择应用手术器械.     

Factors predicting outcome of hypocalcaemia following total thyroidectomy

Postoperative hypocalcaemia is often observed after total thyroidectomy. In patients requiring calcium replacement therapy after 1 year, hypocalcaemia must be considered permanent. The aim of this study was to assess the incidence of hypocalcaemia following total thyroidectomy and to evaluate the risk factors predicting delayed outcome such as hypoparathyroidism. From January 1998 to September 2001, 310 patients underwent total thyroidectomy in our department. In a total of 37 patients experiencing hypocalcaemia, the authors carried out a comparative study of 34 patients with transient hypocalcaemia (group A) and 3 patients with permanent hypocalcaemia (group B). The incidences of transient and permanent hypocalcaemia were 11.9% and 0.9%, respectively. Central neck lymph-node dissection performed in cases of thyroid carcinoma correlated with permanent hypoparathyroidism. The most significant factors predicting long-term outcome of hypocalcaemia were low serum calcium levels (< 8 mg/dl) and high serum phosphorus levels (> 5 mg/dl) measured on postoperative day 7, despite oral calcium replacement. The indications for lymph-node dissection in the central neck area should be very strictly selected. When delayed serum calcium and phosphorus levels are unfavourable, thorough follow-up of patients is mandatory in order to administer the correct therapy and prevent the consequences of chronic hypocalcaemia.     

钳式LigaSure和钳式超声刀在开放性甲状腺全切除术中的应用比较研究

目的比较钳式LigaSure（LSJI）和钳式超声刀（FOCUS）在开放性甲状腺全切除术中的临床应用效果。 方法回顾性分析中山大学孙逸仙纪念医院甲状腺外科2013年6月至10月行开放性甲状腺全切除术的189例患者资料,按照术中使用的辅助工具分为FOCUS辅助下手术组（F组）及LSJI辅助下手术组（L组）,比较两组患者的病史特点、切除甲状腺时间、术中、术后出血量及术后并发症的发生率。 结果L组切除甲状腺平均时间为（35.3±8.6）min,F组为（48.5±9.1）min。切除甲状腺时间长短与术中使用的辅助工具相关,两者之间的差异有统计学意义（P<0.05）;而两组患者的术中、术后出血量、术后血肿发生率、甲状旁腺功能减退发生率、喉返神经损伤性声嘶发生率等差异无统计学意义。 结论LSJI和FOCUS作为甲状腺全切除术的辅助工具均是安全、有效的,但LSJI有助于更高效完成手术。     

Total thyroidectomy is improved by loupe magnification

With this study, we verified if a microsurgical approach with magnification could improve the outcome of total thyroidectomy. Ninety-seven patients were consecutively randomized into group A (surgery with x 2.5 magnification and microsurgical instruments, n = 47) or group B (surgery with no magnification, n = 50). The mean operative time was 125 +/- 4.0 min in group A, and 150 +/- 4.0 min in group B (P = 0.00012). The recurrent laryngeal nerve was identified in all patients of group A, and in 96.8% of group B. The overall morbidity rate was 4.0% in group A and 25.5% in group B (P = 0.0038). This study indicates that a microsurgical approach with magnification is feasible, reduces surgical time, and improves the outcome in total thyroidectomy.     

Surgical treatment of Graves' disease

The surgical treatment of the Graves' disease is no longer a final solution but the main option, as for all the benign thyroid diseases. Between January 1994 and December 2003 in the 3rd Surgical Unit of the Sf. Spiridon Hospital of Ia?i 805 operations were performed for benign thyroid disorders, 78 of which were performed for the Graves' disease. All the patients had been investigated and diagnosed in the Endocrinology Unit of the same hospital, where the necessary medical treatments had been administered. The patients transferred to Surgery had a medium age of 38 (extremes 17-79 years). Women had a greater proportion, as expected (sex ratio F: M = 4.57:1). Some patient had concurrent diseases (5 cases with atrial fibrillation and 3 with chronic hypocalcaemia). 58 total and 20 subtotal thyroidectomy were performed. There were few immediate (3 bleedings which needed reoperation for haemostasis) and late complications (2 cases of postoperative hypocalcaemia which received medical treatment). 4 relapses after previously performed subtotal thyroidectomy were diagnosed and treated. Total thyroidectomy is the treatment of choice for the Graves' disease. The frequency of complications is similar to that occurred after subtotal thyroidectomy, the functional results are immediate, predictable and stable, and the substitutive treatment is very efficient and easy to administer.     

LigaSure vs clamp-and-tie technique to achieve hemostasis in total thyroidectomy for benign multinodular goiter: a prospective randomized study

HYPOTHESIS: Occurrence of adverse effects and advantages of the LigaSure diathermy system (or LigaSure vessel sealing system) in total thyroidectomy have not been tested in prospective randomized studies comparing its use with that of the time-saving clamp-and-tie technique to ligate and divide thyroid vessels. The effectiveness of LigaSure in achieving vessel division and hemostasis remains dependent on vessel diameter, and the risk of damage to adjacent structures cannot be completely excluded. We tested the hypothesis that use of LigaSure compared with the clamp-and-tie technique can significantly and conveniently reduce operative time without increasing postoperative complications in patients undergoing total thyroidectomy for benign multinodular goiter. DESIGN: Prospective randomized study. SETTING: Regional hospital. PATIENTS: Two hundred consecutive patients with benign multinodular goiter undergoing total thyroidectomy performed by 1 of 3 surgeons. INTERVENTIONS: According to a randomized sequence, total thyroidectomy was performed in 100 patients using LigaSure and in 100 patients using the clamp-and-tie technique. MAIN OUTCOME MEASURES: End points of the study included the comparative evaluation of postoperative complications, need for parathyroid gland autotransplantation, operative time, and time to hospital discharge. Preoperative, postoperative (24 hours), and 6-week follow-up serum Ca(++) levels are also reported and compared. RESULTS: The postoperative complication rate was 35% overall, including all transient postoperative disturbances. The incidence of cervical hematomas was 2%, but 3 patients (1.5%), 1 in the LigaSure group and 2 in the clamp-and-tie group, required repeat operations because of respiratory tract obstruction. The incidence of permanent complications was 2.5% overall, including 3 patients (1.5%) with permanent hypocalcemia and 2 patients (1%) with permanent recurrent nerve lesions. No statistical difference in the incidence of complications was found between the 2 study groups. Similarly, no difference was found in mean hospitalization time and need for parathyroid gland autotransplantation. Preoperative, postoperative, and 6-week follow-up mean serum Ca(++) levels were not statistically different in the 2 study groups and in the subset of patients undergoing parathyroid gland autotransplantation. Mean operative time was significantly shorter in the LigaSure group, although the mean difference between the 2 study groups was minimal (7.4 minutes). Concomitantly, there was an additional cost of 45euro (US $57.40) per operation using LigaSure. CONCLUSION: The use of LigaSure is equally as safe and effective at vessel division and homeostasis as the clamp-and-tie technique, with a statistically significant (although minimal) decrease in mean operative time. Because of this minimal decrease in operative time, use of LigaSure would allow more patients to undergo total thyroidectomy each year, which would eventually help to offset its higher cost.     

Thyroidectomy with LigaSure

Purpose

A new method for ensuring hemostasis during thyroid surgery has recently been introduced. This technique, electrothermal (LigaSure) and ultrasound blood vessel sealing, is still experimental. The aim of the present study was to evaluate the applications and efficacy of LigaSure by analyzing the duration of the surgery and the rate of complications of the surgical procedure.

Methods

A total of 23 patients who underwent the LigaSure operation (n_LS group) were analyzed in a prospective nonrandomized/partly randomized clinical study, and were compared with patients who underwent treatment using the conventional (ligature) surgical technique.

Results

At our institutions, 187 patients were treated surgically for thyroid disease in 2006, and 23 of these patients were treated using LigaSure. The complication rate in the patients treated with LigaSure (n_LS: 4.3%) was lower than those who received conventional ligature surgery. However, given the small number of patients, this difference was not statistically significant (retrospective group n₁: 10.7%; nonrandomized group n₂: 9.8%; and randomized group n₃: 9.1%). The length of surgery in the LigaSure group (n_LS = 65 ± 3 min) was significantly shorter (P < 0.001) compared with both nonrandomized (n₂ = 71 ± 6 min) and randomized (n₃ = 70 ± 4 min) patients who received a conventional ligature.

Conclusions

The application of LigaSure using meticulous surgical technique provides a new option for a safe thyroidectomy. Moreover, the duration of the LigaSure procedure is significantly shorter, and there are fewer complications as compared with the classic surgical thyroidectomy technique.     

The use of a vessel sealing system in thyroid surgery

Thyroidectomy is one of the most common operations performed for thyroid diseases throughout the world and has an extremely low morbidity rate. Although the technique of thyroidectomy has changed little for several years, different techniques have been developed for haemostasis in addition to the conventional methods. The vessel sealing system (Ligasure) is a new technology that can be applied in several surgical situations. However, there is no data in the literature regarding its use in thyroid surgery. Fifteen consecutive euthyroid patients (ten women, five men) with a range of 37-71 years of age who met the inclusion criteria were studied. The surgical procedures were performed by a single surgeon using standard techniques, but all vascular structures encountered were sealed by Ligasure and no suture material was used. The pre-operative, intraoperative and postoperative parameters were recorded and analyzed. Fluid collection was evaluated by ultrasonography and clinical examination on the 3rd postoperative day, The results were compared with the conventional knot tying method in a group of 25 patients. A Ligasure device was successfully used in 15 consecutive procedures, including ten total thyroidectomies, three hemithyroidectomies, one subtotal thyroidectomy and one near-total thyroidectomy. There was no operative mortality or technique-related morbidity in patients. The operating time was 75 +/- 11 minutes. The mean volume of the resected thyroid specimens was 68.3 +/- 18.9 cm3. The mean fluid collection at postoperative day three was 7.5 +/- 1.6 cm3. In conclusion, we have found that a Ligasure device can be safely used for haemostasis in thyroid surgery. It has the potential to decrease the operating time, fluid collection and blood loss.     

Benign thyroid disease: 20-year experience in surgical therapy

This retrospective study compares recurrence and postoperative complication rates after isthmo-lobectomy and subtotal thyroidectomy (group I) vs near-total and total thyroidectomy (group II) for benign thyroid disease. Seven hundred and forty-three patients were operated on for thyroid diseases over the period from 1977 to 1998. We considered 202 patients operated on for benign thyroid disease from 1988 to 1998. The follow-up ranged from 1 to 10 years (mean: 3.4 yrs). One hundred and thirty-two patients (65.3%) were operated on for bilateral nodular goitre, 35 (17.3%) for unilateral nodular goitre, 14 (6.9%) for toxic goitre and 21 (10.4%) for thyroiditis. Over the period 1988-1992, 19 patients underwent isthmo-lobectomy and 71 subtotal thyroidectomy (group I). From 1993 to 1998, 39 patients underwent near-total thyroidectomy and 61 total thyroidectomy (group II). The relapse rate was 14.4% in group I, while there were no recurrences in group II (p = 0.000064). Temporary hypocalcaemia was significantly higher (p = 0.000001) in group II (29%) than in group I (2.2%). Within group II, the rate was significantly higher (p = 0.0013) after total thyroidectomy (37.7%) than after near-total thyroidectomy (15.4%). In our experience, near-total and total thyroidectomy are an appropriate approach for preventing recurrence in patients with benign thyroid disease despite the fact that the risk of temporary hypocalcaemia is higher than after less radical surgery. Near-total thyroidectomy and the exercise of all due care in the surgical technique may help to reduce its incidence.     

Electrothermal bipolar vessel sealing system is a safe and time-saving alternative to classic suture ligation in total thyroidectomy

BACKGROUND: Total thyroidectomy is associated with minimal morbidity. The electrothermal bipolar vessel sealing system is an adjunct to the surgical technique, recently made available to thyroid surgery. METHODS: This is a prospective randomized trial of total thyroidectomies performed in single unit from July 2003 to May 2004. Patients were randomly assigned in two groups: group A (n = 90), total thyroidectomy with the classic suture ligation technique; and group B (n = 94), total thyroidectomy with the use of the electrothermal bipolar vessel sealing system. RESULTS: Operative time was significantly reduced in group B by 14 minutes (mean difference, 14.3 +/- 4.2 minutes, 95% CI, 5.88-22.6 minutes). No statistically significant differences were found in postoperative complications, postoperative serum calcium measurements, or hospital stay between the two groups. CONCLUSIONS: The electrothermal bipolar vessel sealing system is a safe and useful, time-saving adjunct for total thyroidectomy.     

Thyroid surgery: total and partial resection. Analysis of complications and a review of the literature

The authors review the recent international literature relating to approximately 36,800 cases of thyroid surgery, analysing the complications associated with total thyroidectomy versus partial resection of the thyroid, with a view to drawing up lines of conduct in terms of indications for surgery of benign disease and suggestions on surgical technique to reduce complications such as recurrent laryngeal nerve injuries (transient and definitive), hypocalcaemia (transient and definitive) and superior laryngeal nerve injuries.     

The use of LigaSure in patients with hyperthyroidism

Background Thyroidectomies of hyperthyroidic patients are known to be more blood-spattered than the operations performed for euthyroid nodular diseases and require careful hemostasis. Our purpose was to evaluate the efficacy of the use of LigaSure in patients with hyperthyroidism.Materials and methods Between January 2004 and October 2005, 100 patients underwent total or near-total thyroidectomy. Bipolar vessel ligation system (LigaSure) was the choice of modality for hemostasis in half of these patients, and the conventional suture ligation technique was used for the rest. The following data were evaluated non-randomized and prospectively in this study: patients demographics, thyroid pathology, operative duration, presence of complications, and the duration of the hospital stay. Comparisons of the data were evaluated by the Wilcoxon and chi-square tests.Results Among the patients of the LigaSure group, 14 patients were detected to have hyperthyroidism (seven patients with Graves’ disease and another seven patients with multinodular toxic goiter), while 36 patients were found to be euthyroidic. The durations of the operation time and of the hospital stay of the patients in the LigaSure group were significantly lower than the conventional thyroidectomy group (p<0.05). The complication rates of the LigaSure and conventional thyroidectomy groups were 4 and 6%, respectively (p>0.05).Conclusions The use of LigaSure as an operative technique in the treatment of Graves’ disease and toxic goiter is a safe and effective modality that provides a shorter hospital stay and a shorter operation time as well.Presented at the International Symposium “Modern Technologies in Thyroid Surgery”, 10–11 February 2006, Halle/Saale, Germany