Abstract
BackgroundWe conducted a systematic review to evaluate the role of Ultrasonic dissector (UAS) versus conventional clamp and tie in thyroidectomy.Materials and methodsWe 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.ResultsThere 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.ConclusionThis 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.
Highlights
The basis for the thyroid surgery was founded by Theodor Billroth and Theodor Kocher, between 1873 and 1893, that standardized and precise anatomical dissection with preliminary ligation of the two principalDuring the last ten years MIVAT (Minimally invasive video assisted throidectomy) was standardized by Miccoli in 1999 [2], and various devices were introduced in order to do a safe section and haemostasis of thyroidal vessels (LigaSure and Ultrasonic dissector) [3]
The analysis showed that the patients who were treated with USA presented more favourable results in incidence of post-operative complications, these data didn’t present statistical relevance
The analysis showed that the patients who were treated with Ultrasonic dissector (UAS) presented more favourable results in incidence of post-operative complications, these data didn’t present statistical relevance
Summary
The basis for the thyroid surgery was founded by Theodor Billroth and Theodor Kocher, between 1873 and 1893, that standardized and precise anatomical dissection with preliminary ligation of the two principal. During the last ten years MIVAT (Minimally invasive video assisted throidectomy) was standardized by Miccoli in 1999 [2], and various devices were introduced in order to do a safe section and haemostasis of thyroidal vessels (LigaSure and Ultrasonic dissector) [3]. The UAS works at lower temperature (ranging from 50° to 100°C) than electrosurgical device. The aim of this systematic review is to evaluate the actual role of UAS versus conventional clamp and tie (CT) in total thyroidectomy. We conducted a systematic review to evaluate the role of Ultrasonic dissector (UAS) versus conventional clamp and tie in thyroidectomy
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