Sutureless Thyroidectomy Research Articles

Sutureless Thyroidectomy Using Electrosurgical Devices

Sutureless Thyroidectomy Using Electrosurgical Devices

Comparison Between Conventional and Sutureless Thyroidectomy

Objective: The main purpose of this study is to compare the outcomes between conventional and sutureless (Harmonic® FOCUS) thyroidectomy. Study Design: Prospective/ Comparison study Place and Duration: de'Montmorency College of Dentistry, Lahore.Nov 2019-Aug 2020 Methods: There were eighty patients of ages 20-70 years were presented in this study. All the patients had multinodular, primary and secondary goitre. Patients provided written consent for the detailed demographics included age, sex and body mass index. The patients were separated into two groups, I and II, for the study. Group I received conventional technique and sutureless technique was used in group II. Outcomes were operative time, hospital stay, blood loss, post-operative drainage volume and complications assessed and compared among both groups. We used SPSS 20.0 version to analyze complete data. Results: In group I 35.34±6.55 years was the mean age with mean BMI 25.15±7.21 kg/m2 and in group II mean age was 36.23±4.31 years with mean BMI 25.15±8.15 kg/m2. There were 25 (62.5%) females and 15 (37.5%) males in group I and in group II 23 (57.5%) females and 17 (42.5%) males. Majority of the patients among both groups had multinodular goitre 32 (80%) and 30 (75%). We found less operative time in group II 60.12±11.52 minutes as compared to group II 81.9±9.34 minutes. Intraoperative blood loss in group I was significant 59.21±7.71 ml as compared to group II 26.4±10.39 ml. Mean drainage volume in group II was lower 10.13±13.23 ml as compared to group I 28.14±5.41 ml. Frequency of complications in group I was higher 5 (12.5%) as compared to group II 3 (7.5%). Conclusion: As a result of this study, we determined that the sutureless thyroidectomy approach was a successful and safe alternative to conventional thyroidectomy in terms of reduced operative time, hospital stay, and post-surgical problems when compared to conventional thyroidectomy. Keywords: Sutureless, Conventional, Thyroidectomy, Multinodular Goitre, Complications

Comparison of effects of energy based devices on quality of life after sutureless thyroidectomy.

Objective:In current literature, no studies evaluated effect of energy-based vessel-sealing-devices on quality of life after sutureless total thyroidectomies. This study aimed to identify any potential differences between two energy-based vessel-sealing-devices (Harmonic Focus, Ligasure LF1212) in patients with benign thyroid disorders who underwent sutureless total thyroidectomy.Materials and methods:Differences in quality of life of patients were evaluated using data obtained by Thy-PRO-39-Tr questionnaire prior to and four-week after surgery. Total and domain-based alterations in quality of life were compared between groups according to energy-based vessel-sealing-devices type (Group L, Group H). Additionally, data including demographics, height, weight, body mass index, neck circumference, sternomental distance were collected.Results:Of 1032 patients, 200 were eligible for study, at the end 193 were analysed. There were no differences between groups in terms of age, sex, body mass index, tobacco use. Analysis did not reveal any differences in overall quality of life between groups (P = .42). However, in “eye symptoms” (P < .001) and “cognitive functions” (P = .002) domains, Harmonic provided statistically improved quality of life. Effect on cognitive function was greater in patients of advanced age.Conclusions:Especially in elderly patients with worsening eye conditions and cognitive functions, use of Harmonic may enhance patients’ outcome by increasing quality of life in addition to optimizing surgical outcome when compared to Ligasure.

Sutureless Total Thyroidectomy for Substernal Goiter: Amending Versus Unnecessary.

Substernal goiter is an enlarged thyroid gland, harboring a component extending into the mediastinum. Surgical management requires genuine and rigorous preoperative planning as physicians could encounter the prospect of the gland coming into close quarters with the vital intrathoracic structures. The neck and chest multiplanar cross-sectional imaging provide essentialness of an extracervical approach for the procedure. In the present study, a 57-year-old female who admitted with the intermittent dyspnea and dysphagia with a huge goiter is reported. The labs were reported within the normal limits and the video laryngoscopy displayed no pathologic finding. Her neck sonography revealed the multiple nodules within the gland, without determining the most proximal border of the left lobe. The neck and chest computed tomography depicted a substernal goiter harboring the left lobe, extending till the left innominate vein and a sutureless total thyroidectomy by the collar incision without a median sternotomy was performed. We would recommend sutureless thyroidectomy for substernal goiter just considering to divide meticulously the superior thyroid arteries and veins separately and exploring the fibrous Ligament of Berry, that is, the true Ligament of Berry, with its safe relationship to the recurrent laryngeal nerve in Thyroidology.

Comparison of outcome of Sutureless Thyroidectomy by Ligasure small jaw verses conventional technique.

Background: Thyroid is a highly vascular gland and hemostasis is a key limiting factor in morbidity and mortality in thyroid surgery. Hemostasis has always been a challenge and various techniques have been used. Vessel sealers like Ligasure are now gaining popularity. Objectives: The objective of this study is to compare thyroidectomy by Ligasure with conventional technique in terms of mean operative time and post-operative blood loss. Study Design: It is a Randomized Control Trial. Setting: Surgical Department of Allied Hospital Faisalabad. Period: Six months (March 2017 to August 2017). Material &amp; Methods: After approval of study from ethical review committee and informed consent, the patients were subjected to complete history and clinical examination in addition to baseline investigations. Total 135 patients of multinodular goiter (MNG) and euthyroid were divided in two groups by simple random sampling. All surgeries were performed under general anesthesia with orotracheal intubation and procedure offered to each patient was subtotal thyroidectomy. Both techniques were compared by measuring the time from opening of pretracheal fascia till its closure in minutes by stop watch and mean was calculated. Post operative blood loss was measured in graduated drain placed in thyroid bed for 24 hours. Results: Mean operative time was recorded as 62.11+4.07 minutes in Ligasure technique group and 73.05+4.01 minutes in conventional technique group. Mean blood loss was recorded as 57.28+3.42 ml in Ligasure technique group and 70.85+4.12 ml in conventional technique group. Conclusion: We concluded that mean operative time and post operative blood loss is significantly lower in cases undergoing thyroidectomy with Ligasure as compared to conventional technique.

Total thyroidectomy: conventional suture ligation technique versus sutureless techniques

Background: Since the introduction of successful thyroidectomy no change occurred in the technique but with the innovation of sutureless surgery, sutureless thyroidectomy becomes a competitor for the conventional technique. In this study we tried to analyze the outcomes of each.Methods: This was a prospective cross armed uncontrolled randomized study included 65 patients suffering from non-malignant goiter who underwent total thyroidectomy, admitted to Sohag University Hospital from September 2017 to October 2018. Patients were randomly allocated into two groups; Group (S) managed with sutureless thyroidectomy, and Group (C) managed with conventional knot tying technique. The data of the patients were gathered and analyzed considering the operative and post-operative outcomes. All patients were followed-up for 6 -12 months.Results: We found a significantly shorter operative time (p=0.001), also the amount of intra-operative blood loss was highly significant less in Group S (p=0.001). There was higher incidence of post-operative pain in Group C (p&lt;0.001), post-operative drainage volume was highly significantly less in Group S (p=0.001). Regarding post-operative complications; the incidence of recurrent laryngeal nerve paralysis (RLNP) was insignificant between both groups (p=0.38), in the same time the incidence post-operative transient hypocalcaemia was significantly more in Group C (P=0.025). The overall post-operative complication rate was significantly more in Group C (p=0.002). The duration of hospital stay was highly significant shorter in Group S (p=0.0001).Conclusions: The use of Harmonic FOCUS® is beneficial for both patient and surgeon; it is efficient and a trustable safe substitute to the conventional knot tying technique.

A rare case of non-surgical vocal cord paralysis: Vocal cord hematoma.

Although vocal cord paralysis (VCP) following thyroidectomy is primarily associated with surgical trauma, it is not the sole etiology. Vocal cord paralysis following thyroidectomy can be caused by a vocal cord hematoma with an incidence of 1.4% due to direct injury during orotracheal intubation. In this article, we present a case of VCP caused by vocal cord hematoma. A 32-year-old male patient who has been receiving propylthiouracil treatment for toxic multinodular goiter since 10 years was admitted to our hospital to be operated because of persisting complaints. The patient was hospitalized for sutureless thyroidectomy after he became euthyroid. Preoperative fiberoptic laryngoscopy performed by the ear, nose, and throat department revealed bilaterally motile vocal folds and a completely open airway. Patient underwent sutureless total thyroidectomy with a vessel sealing device (LigasureTM LF1212, Covidien, CO), and a minivac drainage system was placed in the thyroid lodge. On the morning of the first postoperative day, 50 mL of serosanguinous fluid was drained. The patient's voice was normal, and there was no ecchymosis. Postoperative fiberoptic laryngoscopy revealed a hematoma near the right vocal fold and paralysis of the right vocal fold; however, the airway was open. It should be kept in mind that VCP is not solely due to surgery but can also result from intubation, as observed in this case.

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

Comparison of Hypocalcemia between Conventional Suture Thyroidectomy and Harmonic Sutureless Thyroidectomy

Comparison of Hypocalcemia between Conventional Suture Thyroidectomy and Harmonic Sutureless Thyroidectomy

Sutureless versus conventional thyroidectomy

Background: The thyroid gland is a highly-vascularized organ, prompt and effective hemostasis is a crucial part of the procedure. Nowadays with the major advent of energy devices such as ultrasonic coagulation (Harmonic Scalpel, Ethicon) and bipolar energy (LigaSure, Valleylab) for cutting and hemostasis introducing new methods of vessel ligation and division without increasing the risk of postoperative complications. The aim of this study was to compare the outcome of the use of the Harmonic® FOCUS and conventional suture ligation technique in a prospective comparative study of open total thyroidectomy.Methods: This was prospective comparative study at Sohag University Hospital, Sohag, Egypt. Patients were divided into two groups, the first group included patients who had the Harmonic® FOCUS thyroidectomy group or Sutureless thyroidectomy (S group), and the second group included patients who received Conventional thyroidectomy group (C group).Results: Between September 2014 and September 2016, 69 patients, with thyroid disease were enrolled in this study. 34 patients (49.3%) had a Sutureless total thyroidectomy and 35 patients (50.7%) had a conventional total thyroidectomy, the mean age for Sutureless thyroidectomy was39.85±8.47 years and for conventional group was 43.17±9.69 years. the operative time, intraoperative blood loss, postoperative, drainage volume, transient hypocalcaemia, overall postoperative complications and hospital stay were significantly lower in Sutureless thyroidectomy group. no significant difference between both group as regard recurrent laryngeal nerve function.Conclusions: Sutureless thyroidectomy is the procedure of choice for treatment of thyroid diseases as it had shorter operative time, reduction of overall complications rate and good function results.

Sutureless Thyroidectomy using Bipolar Diathermy and Hypocalcaemia- A Comparative Study In a Tertiary Care Centre

Sutureless Thyroidectomy using Bipolar Diathermy and Hypocalcaemia- A Comparative Study In a Tertiary Care Centre

Sutureless thyroidectomy for controlled toxic goiter: a single-institute experience

Background Total thyroidectomy for controlled toxic goiter is usually associated with more bleeding because of high vascularity of the toxic gland. Several new instruments were developed as hemostatic tools (harmonic scalpel; LigaSure) during total thyroidectomy as an alternative to conventional hemostatic methods. This study aimed to compare the use of Harmonic Focus Scalpel to conventional hemostatic technique (classic suture ligation with standard bipolar diathermy forceps) in patients with controlled toxic goiter undergoing total thyroidectomy regarding operative time, intraoperative complications, postoperative complications, postoperative hospital stay, and return to normal daily activities. Patients and methods The present study included 50 patients with a diagnosis of controlled toxic goiter who underwent total thyroidectomy at the Department of Surgery, Medical Research Institute Hospital, Alexandria University. Candidates were randomized into two groups: group A, in which patients underwent total thyroidectomy using Harmonic Focus Scalpel, and group B, in which patients underwent total thyroidectomy using classic suture ligation and standard reusable bipolar diathermy. Results There was no significant difference between both groups regarding preoperative data (age, sex, comorbidities, and type of thyrotoxicosis). The operative time was significantly shorter in group A patients compared with group B patients (P Conclusion Harmonic Focus Scalpel can be used safely and effectively as a hemostatic tool instead of conventional hemostatic techniques in total thyroidectomy for controlled toxic goiter.

A Novel Method for Managing Postthyroidectomy or Parathyroidectomy Hematoma: Single‐Institution Experience With More Than 4000 Central Neck Operations

We read the article by Dixon et al. [1] with interest and congratulate the authors for their novel method of treating hematomas following thyroid and parathyroid surgery under local anesthesia and also for sharing their challenges in managing these hematomas. Hematomas following thyroid and parathyroid surgeries are at times ephemeral instead of obvious, with no definitive bleeding identified. The surgeon then needs all of his or her experience to tackle this dreaded complication, which has resulted in many surgeons not opting for day surgeries. However, there are certain observations in the article by Dixon et al. that need further clarification and comments that can be of use for future researchers. For instance, did the inexperience of the surgeon result in an increased incidence of hematomas [2]? Did patient characteristics such as muscularity of the individual or hypertension play a role [3]? Did the authors analyze factors such as the size of the goiter and/or retrosternal extension to determine if they increased the incidence of hematoma. As the duration of this study was over a period of 16 years, did the introduction of newer techniques (e.g., sutureless thyroidectomy) and the learning curves result in increased hematomas [4]? Were surgical factors analyzed, such as the type of suture material used for ligation and whether routine use of hemostatic agents (e.g., oxidized cellulose polymer) played a role? We agree with the authors about not using drains routinely [5], but did the authors use a drain after reexploration? Finally, were the patients educated preoperatively about these possible complications? Did a member of the operating team assess the patients before they were discharged?

Sutureless thyroidectomy with energy-based devices: Cerrahpasa experience

Total thyroidectomy makes up the majority of all thyroidectomy cases. Energy-based advanced vessel-sealing devices which were developed in recent years for the control of vascular pedicles allowed significant progress in thyroid surgery. This study is designed to compare the efficiency and safety of the two energy-based vessel-sealing devices (Ligasure™ LF1212 and Harmonic FOCUS(®)) in sutureless thyroidectomy. Two hundred and forty-five consecutive patients underwent sutureless total thyroidectomy. Patients were randomized for the Ligasure™ LF1212 (n = 126) or Harmonic FOCUS(®) (n = 119). The parameters of demographics, surgical indications, morbidity, incision length, duration of operation, weight of specimen, amount of drainage, postoperative pain, hospital stay, and histopathology of specimen were recorded. Mean duration of operation was 37.98 ± 14.98 min (16-92 min) and was significantly shorter for Harmonic FOCUS(®) (p < 0.001). Mean hospital stay was 1.09 ± 0.3 (1-3) days. Morbidity rate was 9.8 % in total, whereas no mortality was observed. In terms of morbidity rates, no significant difference was determined between the two groups (p = 0.476). In both groups, there was no need for extra analgesic application other than the routine given after surgery. According to our experience, sutureless thyroidectomy can be performed with low morbidity rates in secure and efficient way.

English

INTRODUCTION: One of the routinely performed surgery is thyroidectomy. Rates of complications have decreased because of new technologies that are being invented likeligasure, harmonic scalpel and bipolar surgical diathermy. In this study we used bipolar surgical diathermy for thyroidectomy instead of ligasure and harmonic scalpel which are costly and available in higher centers only. MATERIALS: 40 patients with thyroid swelling attending surgical OPD between the period of 2010-2012 were selected. Proper preoperative workup was done local ethical committee approval was taken .thyroidectomy done using bipolar surgical diathermy .patients were reviewed for any complications following thyroidectomy likehaemorrhage, hypocalcemia and recurrent laryngeal nerve palsy. RESULTS: Out of 40 patients who underwent sutureless thyroidectomy none of them had any primary, secondary or reactionary haemorrhage. One patient who underwent total thyroidectomy for follicular carcinoma had transient hypocalcaemia .

Sutureless thyroidectomy using ligasure is safe and results in significant operative time savings

Sutureless thyroidectomy using ligasure is safe and results in significant operative time savings

Sutureless total thyroidectomy: a safe and cost‐effective alternative

Advanced vessel sealing devices provide an alternative to conventional ligation techniques for thyroidectomy. To date, most studies have been inadequately powered to explore differences in the infrequent post-operative complications following thyroidectomy. This study is designed to compare the outcomes of sutureless thyroidectomy and conventional thyroidectomy for recurrent laryngeal nerve (RLN) injury, permanent hypoparathyroidism, and haematoma formation. A cohort study of consecutive patients undergoing total thyroidectomy using conventional versus sutureless techniques was performed. Sutureless thyroidectomy was performed using either Ligasure Precise (Covidien) or Harmonic Focus (Johnson and Johnson) devices. The primary outcome measures were post-operative haemorrhage, permanent RLN injury and hypoparathyroidism. Secondary outcome measures were operative time, temporary hypoparathyroidism and vocal cord dysfunction. A cost minimization analysis comparing the two techniques was performed. From January 2006 to July 2009, 1935 consecutive patients underwent total thyroidectomy. Of these, 772 underwent conventional thyroidectomy and 1163 were performed using a sutureless technique. The mean operative time was significantly lower in the sutureless group (71 versus 86 min, P = 0.02). There was no difference in the post-operative complications of haematoma (0.78% conventional versus 1.12% sutureless, P = 0.46), permanent hypoparathyroidism (1.30% conventional versus 0.52% sutureless, P = 0.06) or permanent RLN injury (0.26% conventional versus 0.52% sutureless, P = 0.39). There was an overall cost saving of AUD$14,300 per 100 total thyroidectomy cases performed using the sutureless technique. Sutureless thyroidectomy is a safe and efficient way of performing total thyroidectomy and has the potential to reduce operating room costs.

Sutureless thyroidectomy: surgical technique

The technique of thyroid surgery has continued to evolve over the last 200 years. Sutureless thyroidectomy is one of the recent developments in surgical technique and is made possible by the use of vessel sealing devices. The most frequently used devices include a bipolar coagulation device (Ligasure Precise) and ultrasonic dissecting shears (Harmonic Scalpel FOCUS). The use of this technology is safe with minimal morbidity and has been shown in numerous studies to significantly decrease operative time. Over 3000 thyroid and parathyroid procedures, both open and minimally invasive, have been performed with vessel sealing devices within the University of Sydney Endocrine Surgery Unit since the technology was introduced in 2005. This manuscript discusses the technique of sutureless thyroidectomy focusing on points of difference in comparison with conventional thyroidectomy using ligatures or clips.

Sutureless Thyroidectomy—Technological Advance or Toy?

Sutureless Thyroidectomy—Technological Advance or Toy?

ES17 *RESULTS OF SUTURELESS TECHNIQUES VS CONVENTIONAL VESSEL LIGATION FOR TOTAL THYROIDECTOMY

Aim: Advanced vessel sealing devices provide an alternative to conventional ligation techniques. Studies into sutureless thyroidectomy (ST) suggest advantages with reduction in operative time, but most were inadequately powered to explore differences in postoperative complications which should be approximately 1%. This study is designed to compare the outcomes of ST and conventional thyroidectomy (CT) for recurrent laryngeal nerve (RLN) injury, permanent hypoparathyroidism and haematoma formation.Method: A cohort study of consecutive patients undergoing total thyroidectomy using conventional vs. sutureless techniques was performed. ST was performed using either Ligasure Precise or Harmonic Focus devices. The primary outcome measures were postoperative haemorrhage, permanent RLN injury and hypoparathyroidism. Secondary outcome measures were operative time, temporary hypoparathyroidism and vocal cord dysfunction.Result: From January 2007 to December 2008, 1449 consecutive patients underwent total thyroidectomy. Of these 725 underwent CT and 724 were performed using ST. The mean operative time was significantly lower in the ST group (44.2 vs. 57.3 min. p = 0.032). There was no difference in postoperative haematoma incidence between groups 0.8% CT vs. 0.7% ST, p = 0.89. The permanent hypoparathyroidism rate was not significantly different between groups 1.2% CT versus 0.4% ST, p = 0.08. There was no difference in the incidence of permanent RLN injury 0.2%CT and 0.4%ST, p = 0.31.Conclusion: Sutureless total thyroidectomy using advanced vessel sealing technology is safe and efficient and has complication rates equivalent to conventional techniques.