Standard Bipolar Diathermy Vessel Ligation for Thyroidectomy

Abstract

Objective Assess the safety and possible advantages of using bipolar diathermy with standard forceps, compared to clamp-and-tie for vessel ligation in thyroidectomy. Methods Retrospective case-control study of 153 patients undergoing thyroid surgery at our unit using the clamp-and-tie technique (January 2000-December 2002), compared to bipolar diathermy with standard bipolar forceps (January 2003-January 2006) for vessel ligation. Patient demographics, operating time, length of hospital stay, need for drain insertion, and complications (recurrent laryngeal nerve palsies, reactionary haemorrhage requiring re-exploration or late (>24h post-op) haematomas, hypocalcaemia) were compared between the two groups. Outcomes were compared using Prism (GraphPad Software, CA, USA). Data sets were initially tested for normal distribution using the D'Agostino and Pearson test of normality before comparison using two-tailed, unpaired t-tests, Mann-Whitney U test, Chi-squared or Fisher exact tests as appropriate, with p<0.05 considered significant. Results Significantly fewer drains were inserted and patients were discharged significantly earlier when standard bipolar diathermy was used for vessel ligation in hemithyroidectomies (p<0.001). The complication rates were similar for thyroidectomy using either technique, comparable to rates in large published series. Conclusions The use of bipolar diathermy with standard forceps for vessel ligation in thyroid surgery has been shown to be as safe and effective as the clamp-and-tie technique, while providing the advantage of the use of fewer drains, resulting in earlier patient discharge. This is a cost-efficient technique as it gives the advantage of reduced inpatient stay seen by others using bipolar vessel sealing devices or the harmonic scalpel, but without the expense.