Hemostasis In Thyroid Surgery Research Articles

The effect of oxidized cellulose use on postoperative hypocalcemia development in thyroid surgery

BACKGROUND
 Hypocalcemia is a frequent complication in patients after thyroid surgery. Especially permanent hypocalcemia is the most common complication and it can cause significant morbidity. Also postoperative haemorhage is uncommon life-threatening complication of thyroid surgery. In this study we compare calcium metabolism and complications between oxidized regenerated cellulose gauze (OC) + conventional haemostasis versus conventional haemostasis in thyroid surgery.
 METHODS
 Two hundred and eighty eight patients were divided in to two groups: Group 1(144 patients) conventional haemostasis, group 2 (144 patients) Oxidized cellulose + conventional haemeostasis. Preoperative and postoperative Ca levels, operation time, hospital stay, complications (bleeding, recurrent laringeal nerve injury, hypocalcemia) were evaluated.
 RESULTS
 There was no significant difference between groups in sex, preoperative and postoperative Ca levels, hospital stay, bleeding, recurrent nerve injury. The avarage age was significantly higher in group 1 compared to group 2( 52,4 years vs 49,6 years, p< 0,05). The operation time was significanly lower in group 2 compared to group 1(77,2 min.vs 87,2 min., p< 0,05). 
 CONCLUSION
 Compared with conventional haemostasis methods, we think that addition Oxidized Cellulose gauze for haemostasis does not create a positive- negative difference in calcium matebolism and does not make a difference in complication rates, while shortening the operation time.

Harmonic scalpel thyroidectomy versus conventional haemostasis thyroidectomy

Background: As there is paucity of data on harmonic scalpel thyroidectomy from Jammu and Kashmir belt. So, we conducted this study to bridge this gap and also to create awareness about the use of harmonic scalpel. Thyroidectomy has become one of the most common and frequent surgery. Hemostasis in thyroid surgery is of utmost importance for a successful surgery. Our aim was to compare operative factors, postoperative outcomes of thyroidectomy using the Harmonic Scalpel (HS) and Conventional Haemostasis (CH).Methods: In this randomized control trial study, 100 patients who underwent thyroidectomy were enrolled and randomly divided in two groups- HS group and CH group. The inclusion criteria were age>18years, acceptance to participate in the study (signed informed consent form) and scheduled total thyroidectomy. The groups were compared with regards to age, gender, operative time, post-operative drainage volume, postoperative pain, and hospital stay.Results: The mean age in years was 39.8 years for HS group and 43.8 years for CH group with female preponderance. There was a significant difference with regards to operative time, post-operative drainage volume, postoperative pain, and hospital stay (p<0.001). Harmonic Scalpel shortens the operative time. And there was less post-operative drainage volume and postoperative pain in HS group. Hospital stay was also less as compared to CH group.Conclusions: HS is superior then CH thyroidectomy and is considered as a safe and better tool in thyroidectomy.

Energy-based devices for hemostasis in thyroid surgery.

The evolution of operative techniques in thyroid surgery that has taken place over the past several decades would not have been possible if not for a sui generis revolution in surgery at the turn of the 19th and 20th centuries. The three most important events of the end of the 19th century, i.e., the introduction of anesthesia, the use of artery forceps and ligation of blood vessels, as well as prophylactic management of perioperative infections decidedly affected the improvement of therapeutic results of thyroid surgery. Surgical treatment of thyroid diseases is associated with the possibility of complications developing, of which bleeding is among the most serious ones, starting from the need for an immediate reoperation and ending at a considerable damage to functionally important structures: the laryngeal nerves and parathyroid glands. The consensus reached between the development of science and progress in modern technologies has provided the basis for introducing and popularizing minimally invasive procedures, including operations using the approach through natural body openings. Such an unprecedented development of surgical techniques would not be possible without devices for closing blood vessels. Given the mechanism of hemostasis, current vascular sealing devices can generally be divided into three groups: ultrasonic, bipolar-radiofrequency and hybrid systems combining both energy modalities. While analyzing the innovative, advanced technology of all the energy-based devices, it should be stated that only if they are used in a safe manner, quality of life of patients with various thyroid conditions is improved. The employment of such devices fully confirms their usefulness; nevertheless, all the advantages should never release the surgeon from the obligation to appropriately and safely identify the surrounding structures and let him uncritically use the new device.

Comparison of Harmonic Scalpel versus conventional hemostasis in Thyroid surgery in terms of per-operative and postoperative outcome.

Harmonic scalpel is popular for use in a variety of surgical procedures including thyroid surgery. Proposed advantages of the harmonic scalpel include less lateral thermal tissue damage with no electrical energy transferred to the patient, no neuromuscular stimulation, less smoke formation as compared with electrocautery. Objectives: Our aim was to compare outcomes following thyroid surgery in terms of operative time, postoperative pain, drainage volume, recurrent laryngeal nerve and parathyroid gland injury with the use of the Harmonic Scalpel compared to conventional methods of hemostasis. Study Design: Randomized control trial. Setting: Surgical Department Lahore General Hospital. Period: Twelve Months June 2016 to June 2017. Material & Methods: 60 patients, 30 in each group. Patients were randomized in each group by balloting method. Operative time, postoperative pain and drainage volume was assessed during hospital stay. Recurrent laryngeal nerve and parathyroid gland injury was assessed during hospital stay and follow-up. Results: There was no significant difference in development of hoarseness of voice in both groups, p-value > 0.05. The mean operative time for group A was 69.47 ± 15.44 minutes and for group B it was 54.93 ± 11.56 minutes, p-value <0.05. The overall blood loss in group-A and group-B was 118.73 ± 50.72 ml and 44.60±10.70 ml, p-value<0.05. The mean post-op pain observed at 2nd day for group B was 2.93 ±3.57 and for group A it was 3.57±0.77, p-value < 0.05. Conclusion: Use of Harmonic Scalpel has better results in thyroid surgery in terms of less operative time, less postoperative pain, less drainage volume, while no RLN & parathyroid injury detected in either group.

ULTRASONIC DISSECTION VERSUS CONVENTIONAL LIGATION COAGULATION IN THYROIDECTOMY

ULTRASONIC DISSECTION VERSUS CONVENTIONAL LIGATION COAGULATION IN THYROIDECTOMY Abdulameer Muhsin Aldaraji MB, ChB, FICMS, General Surgeon, Al-Faiha General Hospital, Basrah, IRAQ. Abstract Ligation and diathermy coagulation was the standard method of hemostasis in thyroid surgery for more than a century. New hemostatic techniques were developed in the 1990th. Ultrasonic dissector used for the first time in thyroidectomy in 1999 by Tokami. Many studies compared the conventional method of thyroidectomy with new ultrasonic dissector technique. These studies found many advantages of the new method including reduction of operative time, shorter incision, decrease blood loss, decrease post operative drainage, shorten hospital stay and decrease complications. This study compared the two methods of hemostasis regarding incision length, operative time and complications. Between March 2012 and March 2015, 143 patients underwent open thyroidectomy involved in a prospective study at Al-Faiha General Hospital. The patients were divided into 2 groups: Group 1, conventional thyroidectomy technique(clamp, tie and diathermy coagulation) included 104 patients. Group 2, ultrasonic dissection technique (sutureless thyroidectomy) included 39 patients. The patient characteristic and postoperative complications were reported. The incision length and the operative time was measured. All patients underwent surgery by the routine pre tracheal strap muscle cutting transeversly (not splitting). In group 2, the ultrasonic dissector was used in strap muscle cutting, sealing §ion of the blood vessels and in the final resection of the gland. The surgical incision length and operative time were compared in both groups. In lobectomy, there was no significant reduction in the length of incision with use of ultrasonic dissector( z value0.05), while in subtotal, total or near total thyroidectomy there was significant reduction in the length of incision (p value

A comparative study between ultrasonic dissector versus conventional methods in achieving haemostasis in thyroid surgery

Aim To compare ultrasonic dissector with conventional methods (suture ligation/ electrocautery) in achieving haemostasis in thyroid surgery.

The use of new energy-based haemostatic methods in thyroid surgery

The application of new energy devices for haemostasis in thyroid surgery is increasingly common nowadays. Although the use of such devices has already been confirmed as a safe method of haemostasis for open and laparoscopic abdominal surgery, their use in vessel ligation and sectioning in thyroid surgery still constitutes a debated issue. There is paucity of guidelines relating to the subject. Literature was searched up to February 2014 in an effort to propose recommendations for the establishment of guidelines concerning the use of both ultrasonic coagulation (Harmonic Scalpel-HS) and bipolar coagulation (Ligasure-LS), the new energy devices that are commonly used in open thyroidectomy. Studies that also compare the conventional clamp-and-tie method of haemostasis in thyroid surgery in relation to the new energy devices are included. Additionally, studies that compare the results among the use of different new energy devices were searched. Conclusions were based on the mainly debated issues of haemostasis, laryngeal nerve damage and hypocalcaemia.

The use of drains in thyroid surgery

With the introduction of new surgical instruments for intraoperative haemostasis in thyroid surgery the probability of postoperative haemorrhage has been reduced. Accordingly, attempts have been made to avoid the insertion of drains after thyroidectomies. However, concerns about patient safety and the risks deriving from avoiding the use of drains have turned them into a controversial issue. There is paucity of guidelines relating to the subject. Existing literature up to February 2014 was searched in an effort to propose recommendations for the establishment of guidelines concerning the use or not of drains in thyroid surgery taking into account the most debated issues of rather rare postoperative complications, namely haemorrhage, airway obstruction, respiratory failure and wound infection. Finally, reference is made to the impact on length of stay and cost of this practice.

The use of FOCUS Harmonic scalpel compared to conventional haemostasis (knot and tie ligation) for thyroid surgery: a prospective randomized study.

Haemostasis is crucial in thyroid surgery to avoid intraoperative and postoperative complications. In the present study, we evaluated the efficiency and the safety of Harmonic scalpel when compared to conventional suture ligation in open total thyroidectomy. We enrolled 265 patients who underwent total thyroidectomy for multinodular disease since October 2011 up to October 2013. They were randomized into two groups: 141 in group HS (Harmonic Scalpel), 124 in group CT (Conventional tecnique). We recorded the following data: operative time, post-operative blood loss, length of hospital stay and complications. The patients were monitored for 48 hours after surgery. Several differences were observed between the two groups (HS vs CT): the use of Harmonic scalpel was associated to a significant reduction of surgical operative time (110 min in CT vs 79.36 min in HS, p = 0.00001) and also associated to a lower blood loss (97.38 ml in CT vs 68.72 ml in HS, p = 0.00001). The length of stay was significantly shorter in the HS group (2.75 days in CT vs 1.93 days in HS) Complication rate was similar in the two groups. According to our experience, the Harmonic scalpel represents a safe alternative to conventional haemostasis in thyroid surgery, allowing for a significant reduction of operative time, blood loss and hospitalization. The rate of complication demonstrated no significant difference among the two groups.

Harmonic scalpel compared to conventional hemostasis in thyroid surgery.

The aim of this study was to determine whether conventional hemostasis (CH) or the harmonic scalpel (HS) results in shorter operative times for thyroidectomy and to evaluate the incidence of postoperative complications with each approach. In this study, 85 consecutive patients undergone open thyroidectomy were randomized into two groups: group CH (conventional hemostasis with classic technique of tying and knots, resorbable ligature, bipolar diathermy) and group HS (harmonic scalpel). Demographics, pathological characteristics, thyroid size, operative time, blood loss, and complications using the Student's t-test and χ (2)-test. The two groups were similar regarding age and sex. There were no intraoperative complications. There was no difference between the two techniques regarding the amount of blood loss for different procedures. No significant differences were found between the two groups concerning mean thyroid weight and mean hospital stay (2.2days in HS vs. 3.7 in CH; P > 0.05). The mean operative time was significantly shorter in the HS group (47.2min vs. 79.2min; P < 0.001). Two (4.7%) transient recurrent laryngeal nerve palsies were observed in the CH group and no one (0%) in the HS group. No patient developed permanent palsy. Postoperative transient hypocalcemia occurred more frequently in the CH group (21/43, 48% vs. 7/42, 16%). In patients undergoing thyroidectomy, HS is a reliable and safe tool. Comparing with CH techniques, its use reduces operative times, postoperative pain, drainage volume, and transient hypocalcemia.

Hemostatic Systems in Thyroid Surgery and Complications

IntroductionThere have been significant technological advances for hemostasis in thyroid surgery, that allow more precise and safer vascular sealing than the traditional bond associated with mono- or bipolar electrocoagulation. ObjectiveTo compare the complications in total thyroidectomy using traditional techniques (ligation and electrocoagulation, including LigaSure) compared to the exclusive use of the Ultracision Harmonic scalpel, performing dissection, cutting and hemostasis simultaneously. MethodsRetrospective descriptive non-randomised comparative study with 887 patients who underwent total thyroidectomy by the same surgeon. They were distributed into Group A (traditional techniques in 468 patients, January 1997 to September 2006) and Group B (Harmonic Ultracision in 419 patients, October 2006 to May 2010). ResultsThere was a statistically significant lower incidence of complications in Group B (0.95% versus 4.06% in group A): bleeding (0.24% versus 1.92% in group A), tracheostomy (0% versus 1.28%) and intensive care unit stay (0% versus 4.06%). Improvement of surgical activity parameters was also significant for Group B: shorter operation time (60min versus 180min), fewer hospital stays (4.62 versus 8.5 stays) and increase in operations per month (9.63 versus 4 interventions). Persistent sequelae (recurrent paralysis [0.48%] and hypoparathyroidism [0.47%]) decreased in the second group but the difference was not statistically significant compared to Group A. The cost per patient was lower in Group B. ConclusionsThe Ultracision Harmonic scalpel system is the technique of choice for thyroid surgery.

Sistemas de hemostasia en cirugía tiroidea y complicaciones

Introduction There have been significant technological advances for hemostasis in thyroid surgery, which allow more precise and safer vascular sealing than the traditional bond associated with mono- or bipolar electrocoagulation. Objective To compare the complications in total thyroidectomy using traditional techniques (ligation and electrocoagulation, including LigaSure) compared to the exclusive use of the Ultracision Harmonic scalpel, performing dissection, cutting and hemostasis simultaneously. Methods Retrospective descriptive non-randomized comparative study with 887 patients who underwent total thyroidectomy by the same surgeon. They were distributed into Group A (traditional techniques in 468 patients, January 1997 to September 2006) and Group B (Harmonic Ultracision in 419 patients, October 2006 to May 2010). Results There was a statistically-significant lower incidence of complications in Group B (0.95% versus 4.06% in group A): bleeding (0.24% versus 1.92% in group A), tracheostomy (0% versus 1.28%) and intensive care unit stay (0% versus 4.06%). Improvement of surgical activity parameters was also significant for Group B: shorter operation time (60 minutes versus 180 minutes), fewer hospital stays (4.62 versus 8.5 stays) and increase in operations per month (9.63 versus 4 interventions). Persistent sequelae (recurrent paralysis [0.48%] and hypoparathyroidism [0.47%]) decreased in the second group but the difference was not statistically significant compared to Group A. The cost per patient was lower in Group B Conclusions The Ultracision Harmonic scalpel system is the technique of choice for thyroid surgery.

Hemostasis in thyroid surgery: Harmonic scalpel versus other techniques—a meta-analysis

Objective The objective is to systematically review the literature studying the harmonic scalpel versus other hemostatic techniques in thyroid surgical patients. Although thyroidectomy is one of the most common surgical procedures, the safest, most efficient, and cost-effective way to achieve hemostasis is hotly debated. Data Sources We searched the electronic databases Medline and the Cochrane Library using relevant search strategies. Review Methods Two reviewers (G.W., T.E.) independently assessed titles and abstracts of 72 identified studies. Twelve prospective randomized controlled studies were considered relevant and included in this meta-analysis (1153 patients). Results In all studies, operating time was reduced by using the harmonic scalpel. Compared with surgical hemostasis by suture ligation or suture/clip ligation combined with electrocauterization or electrothermal bipolar vessel sealer (n = 602), the mean operating time reduction for the harmonic scalpel was equivalent to 22.67 minutes (95% CI, −27.98; −17.37, P < 0.00001) or nearly 25 percent of the total operating room time. When harmonic scalpel was used, blood loss was reduced significantly by 20.03 mL (95% CI, −27.83; −12.22, P < 0.00001), and a mean reduction in postoperative pain (0.86 points [95% CI, −1.60; −0.13, P = 0.02]) was measured. Length of stay was reduced by 0.12 days (95% CI, −0.25; 0.00, P = 0.05). Differences regarding volume of drainage fluid were in favor of harmonic scalpel but not statistically significant; complications were similar in both groups. Conclusion There is clear evidence that using the harmonic scalpel for hemostasis in thyroid surgery significantly reduces operating time and blood loss and that it is not associated with an increase in volume of drainage fluid, complication rate, or hospital stay.

Harmonic Scalpel Compared to Conventional Hemostasis in Thyroid Surgery: A Meta-Analysis of Randomized Clinical Trials

Background. The study's aim was to determine whether conventional hemostasis (CH) or the Harmonic Scalpel (HS) results in shorter operative times for thyroidectomy and to evaluate the incidence of postoperative complications with each approach. Methods. A literature search was conducted from study inception to September 30, 2008. Included studies randomized thyroidectomy patients to either CH or HS and reported the incidence of postoperative transient recurrent laryngeal nerve dysfunction (RLND) and hypocalcemia. Results. Nine RCTs were included. Use of the HS reduced operative time by 23.1 minutes (95% CI = 13.8, 32.33). There was no difference in the incidence of transient RLND (RR = 1.25, 95% CI = .56, 2.76), but a lower rate of transient hypocalcemia with the use of the HS (RR = .69, 95% CI = .51, .92). Conclusions. The use of HS in thyroidectomy significantly reduces operative time and is associated with a reduction in postoperative hypocalcemia compared to CH.

Novel hemostatic devices in thyroid surgery: electrothermal bipolar vessel sealing system and harmonic scalpel

Accurate and efficient hemostasis is one of the first priorities of the thyroid surgeon to prevent or minimize complications, including injury to the laryngeal nerves or parathyroid glands, perioperative hemorrhage and the potentially life-threatening hematoma. Means to prevent and control intra- or postoperative bleeding therefore remain a topic of utmost importance. Although thyroidectomy is one of the most common surgical procedures, the safest, most efficient and cost-effective way to achieve hemostasis is debated by endocrine surgeons and otorhinolaryngologists. In our opinion, there is no substitute for meticulous surgical technique and hemostasis, while experience in such operations is essential for the best outcome with the fewest complications. Ties, suture-ligations, monopolar/bipolar diathermy, clips, and hemostatic agents/sealants or tissue adhesives have been used. Over the last 10 years, innovative hemostatic devices, such as the electrothermal bipolar vessel sealing system and ultrasonically activated shears, have been developed and have been welcome adjuncts to the thyroid surgeon’s armamentarium. In this review we aim to cover both novel and well-established traditional techniques of hemostasis in thyroid surgery, with specific focus on the bipolar vessel sealer and harmonic scalpel.

The Harmonic Scalpel Technique Without Supplementary Ligation in Total Thyroidectomy with Central Neck Dissection

To investigate the safety and efficacy of the no-tie (NT) technique using the harmonic scalpel (HS) in terms of the operating time and complications in total thyroidectomy with central neck dissection (CND). Recently, the HS has been used as an alternative to conventional hand-tied ligation for hemostasis in thyroid surgery, which is a time-consuming procedure. Limited data have been published on the evidence of its safety in total thyroidectomy accompanied by CND without supplementary hand-tied ligation. Sixty-five consecutive thyroidectomized patients were enrolled in this study. The final pathology in all the patients was thyroid papillary carcinoma. All patients underwent total thyroidectomy with CND. The NT technique using HS group consisted of 31 patients. The conventional hand-tied ligation technique group comprised 34 patients. The following variables were examined: operating time, intraoperative bleeding, incidence of perioperative complications (hemorrhage, hematoma, seroma, recurrent laryngeal nerve palsy, hypoparathyroidism, and injury to the adjacent structures including the trachea and esophagus), the number of pathologically proven lymph nodes, total amount of drainage, duration of drain placement, and time of hospital discharge. The use of the HS reduced the operating time of total thyroidectomy with CND by an average of 43.12 minutes (P < 0.001). The number of pathologically proven lymph nodes was 7.32 +/- 1.66 in the NT group and 6.85 +/- 1.76 in the CT group (P = 0.274). No significant difference was observed in the overall perioperative complications, such as postoperative bleeding, temporary recurrent laryngeal nerve palsy, and temporary hypoparathyroidism, between the 2 groups. No permanent recurrent laryngeal nerve palsy and hypoparathyroidism occurred in either group. The NT technique with the HS is a relatively safe and effective method in total thyroidectomy combined with CND. Moreover, the HS significantly reduced the operating time.

The use of a harmonic scalpel in thyroid surgery: report of a 3-year experience

Background Hemostasis in thyroid surgery is of utmost importance for a successful surgery and an uneventful postoperative course. The present article reports a single surgeon’s 3-year experience in the use of the harmonic scalpel. The device was developed in the early 1990s and offered adequate and safe hemostasis for vessels up to 3 mm in width. Methods This was a prospective observational study. Data sheets from all patients who had surgery by a single endocrine surgeon in the period from 1999 to 2004 were evaluated. Patients were divided into 3 groups based on the surgical technique used: group I comprised the conventional knot-and-tie technique, group II comprised the ligation of all but the superior thyroid vessels with a scalpel, and group III comprised patients in whom the device was used exclusively. The groups were compared in regard to surgical time, cost, and complication rate. Results A total of 272 patients were included in the study: 107 patients were included in group I, 77 in group II, and 88 group III. The surgical time of group I differed significantly compared with groups II and III ( P < .0001 in both cases). Surgical times between groups II and III did not differ significantly ( P = .701). Conclusions The use of the harmonic scalpel reduces surgical time, but it increases the cost of the surgery. It is our belief that by including in the absolute cost the time saved and the reduction in human resources needed, the use of the scalpel would prove to be economic.

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.