Reply to G. Dionigi’s letter: energy based devices and recurrent laryngeal nerve injury: the need for safer instruments

Abstract

Sir, Professor Dionigi’s concern expressed in his Letter to the Editor with respect to safety of modern thyroid surgery employing energy-based devices for tissue dissection and hemostasis is of great clinical importance [1]. Thyroid operations that minimize the cervical incision and extent of the dissection have some advantages over conventional cervicotomy in terms of lower postoperative pain and improved cosmetic results [2]. However, safety remains the most crucial aspect of these approaches, particularly considering that the major indication for minimally invasive video-assisted thyroidectomy (MIVAT) is a small and benign thyroid nodule, which represents the easiest to treat group of thyroid pathologies. In such cases, morbidity should be at least equal to or even lower after minimally invasive thyroidectomy as compared to its conventional equivalent. A large, uncontrolled prospective series of MIVAT procedures indicated that prevalence of the recurrent laryngeal nerve injury varies from 1.7% to 2.4% for transient events and 0.8% to 1.1% for permanent events [3– 5]. A recent meta-analysis of randomized controlled trials comparing the MIVAT operation with open thyroidectomy suggested that there was no statistically significant difference in prevalence of either transient laryngeal nerve palsy or transient hypoparathyroidism. In the majority of these series, ultrasonic harmonic shears were used. In conclusion of the aforementioned meta-analysis, MIVAT was regarded