Use of Ligasure Sealing Versus Conventional Suture - Ligation in Total Thyroidectomy

Abstract

<b>Introduction:</b> Effective vessel haemostasis can be achieved by suture knot tying technique or newer techniques of vessel haemostasis like ligasure as an alternative bipolar surgical diathermy system. Various diathermy techniques have been proposed to reduce intraoperative blood loss in surgery and the new electrothermal bipolar tissue sealing system (Ligasure) has been applied in various specialties of surgery. The objective of this randomized study was to compare the outcome of ligasure versus conventional clamping and tie in total thyroidectomy for benign thyroid diseases. <b>Patients and Methods:</b> A total of 200 patients diagnosed to have bilateral BMNG were subjected to primary total thyroidectomy and divided into two main groups Ligasure (L) and Suture-Ligation (SL). For detection of laryngeal nerves status, vocal cords were checked immediately postoperatively by laryngoscope and at the day 10 of postoperative period to assess the status of both laryngeal nerves. The function of the parathyroids was checked by detecting the serum calcium concentration and parathyroid hormone level. The following parameters were measured to compare the effect of ligasure versus conventional suture-ligation technique in decreasing the operative blood loss, operative time, securing laryngeal nerves and parathyroids, postoperative drainage and postoperative wound infection. <b>Results:</b> There was no statistical difference between the two groups regarding age, sex and body mass index and also there was no operative mortality. As regard the operative time, in ligasure group it was 115.54 &plusmn;15.35 minutes while in suture-ligation group was 127.1 &plusmn;7.95 minutes and intraoperative blood loss in group A was 62.06 &plusmn; 7.34 and in group B was 75.84± 9.21. Temporary RLN injury was detected in 3 patients (3%) in group A and in 5 patients in group B (5%). No permanent hypoparathyroidism was seen in group A patients but in one patient (1%) of group B, transient hypoparathyroidism occurred in 2 patients (2%) of both groups. The amount of fluid drained in group A was 54.16 &plusmn;9.21 and 66.28 &plusmn;8.99 in group B. <b>Conclusion:</b> The use of the Ligasure sealing system in total thyroidectomy is proved safe and effective in reducing the operative time, intraoperative blood loss together with reduction in postoperative fluid drainage. Owing to the ability to reduce energy spread profile, use of Ligasure sealing system is accompanied with better outcome regarding the function of laryngeal nerves and parathyroids.