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Montori G, Botteri E, Ortenzi M, Gerardi C, Allocati E, Giordano A, Vettoretto N, Arezzo A, Huo B, Bergamini C, Podda M, Agresta F. Systematic review and meta-analysis of the use of high-energy devices for thyroid surgery. Langenbecks Arch Surg 2024; 409:217. [PMID: 39017727 DOI: 10.1007/s00423-024-03399-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 06/26/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND We conducted a systematic review and meta-analysis to evaluate the role of High Energy Devices (HEDs) versus conventional clamp and tie technique in thyroidectomy. This work is endorsed by the Italian Society of Surgical Endoscopy (Italian Society of Endoscopic Surgery and new technologies-SICE) in the broader project on the evaluation of the role of HEDs in different surgical settings with the full health technology assessment report. MEHODS Inclusion criteria were adult patients (≥ 18 years old) undergoing Thyroidectomy/Parathyroidectomy conducted with High Energy Devices (as ultrasonic (US), radiofrequency (RF), and hybrid energy (H-US/RF)) in the setting of thyroid surgery (both partial and total) for benign and malign diseases. However, some variability was found in included studies and described in the text. This systematic review and meta-analysis were performed according to the Cochrane handbook for systematic reviews, and the recommendations of the 2020 updated Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines were pursuit. Selection of abstracts was performed in Ryyan system by 2 independent reviewers, and doubts were solved by another independent reviewer. At the end of literature research, Randomized controlled trials and observational studies were included. Risk of Bias was assessed with ROB2 for RCTs, and New Castle Ottawa Scale for Observational studies. RESULTS The literature search yielded 47 studies, including 29 RCTs and 18 observational studies. Meta-analysis was performed for 29 randomized clinical trials. Outcomes included in the comparison between High Energy Devise and conventional technique groups were operative time, operative blood loss, overall post-operative drainage volume, length of stay, complications, and costs. HED significantly reduced operative time (28 studies, 3097patients; MD -128.8; 95% CI -34.4 to -23.20; I2 = 96%, p < 0.00001, Random-effect), intra-operative blood loss (13 studies, 642 vs 519 patients; SMD -0.82; 95% CI -1.33 to -0.32; I2 = 93%, p < 0.00001, Random-effect), LOS (22 studies, 2808 vs 2789 patients; MD -0.38, 95% CI -0.59 to -0.17; I2 = 98%, p < 0.00001 Random-effect), and healthcare costs (8 studies, 1138 vs 1129 patients, SMD 1.05; 95% CI -0.06 to 2.16; I2 = 99%, p < 0.00001 Random-effect). The rate of overall intraoperative complications was significantly different between both groups (25 studies, 2804 vs 2775 patients; RR 0.88, 95% CI 0.80 to 0.97; I2 = 38%, p = 0.03 Random-effect), but the sensitivity analysis did not find a statistically significant difference (6 studies, 605 vs 594 patients, RR; 95% CI to; I2 = 0%, p = 0.50, Random-effect). There was no difference in the subgroup analysis for the occurrence of transient and permanent RLN palsy, nor hematoma formation and hypocalcaemia. DISCUSSION Though findings of our systematic review and metanalysis are limited by heterogeneous data, surgeons, hospital managers, and policymakers should note that the use of High Energy Devices compared to conventional clamp and tie technique have reduced operative times, intra-operative blood loss, length of stay, and hospital costs in patients underwent to tyroid surgery. Future work must explore issues of equity to mitigate barriers to patient access to safe thyroid surgical care and define better this initial results.
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Affiliation(s)
- Giulia Montori
- Department of General and Emergency Surgery, Vittorio Veneto Hospital, Vittorio Veneto (Treviso), Italy.
| | - Emanuele Botteri
- General Surgery, ASST Spedali Civili Di Brescia PO Montichiari, Brescia, Montichiari, Italy
| | - Monica Ortenzi
- Department of General Surgery, Università Politecnica Delle Marche, Piazza Roma 22, 60121, Ancona, Italy
| | - Chiara Gerardi
- Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | | | - Alessio Giordano
- Department of Emergency, Emergency General Surgery Unit, AOU Careggi, Florence, Italy
| | - Nereo Vettoretto
- General Surgery, ASST Spedali Civili Di Brescia PO Montichiari, Brescia, Montichiari, Italy
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Turin, Italy
| | - Bright Huo
- Division of General Surgery, Department of Surgery, Ma, Hamilton, Canada
| | - Carlo Bergamini
- Department of Emergency, Emergency General Surgery Unit, AOU Careggi, Florence, Italy
| | - Mauro Podda
- Department of Surgical Science, Emergency Surgery Unit, University of Cagliari, Cagliari, Italy
| | - Ferdinando Agresta
- Department of General and Emergency Surgery, Vittorio Veneto Hospital, Vittorio Veneto (Treviso), Italy
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Hameed I, Khan MO, Samad SA, Mahmood S, Siddiqui OM, Hameed I, Nashit M, Iqbal A, Marsia S, Al Shetawi AH. Is Using the Harmonic Scalpel Better than Conventional Hemostasis in Neck Dissection? A Meta-Analysis. Craniomaxillofac Trauma Reconstr 2024; 17:74-86. [PMID: 38371216 PMCID: PMC10874208 DOI: 10.1177/19433875231170924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024] Open
Abstract
Study Design Systematic review and meta-analysis. Objective The clinical decision to pursue harmonic scalpel (HS) method vs conventional hemostasis to treat head and neck cancers has been arguably predicated on the clinical outcomes observed. This study aims to evaluate the surgical outcomes of neck dissection between both techniques and perform an updated meta-analysis using the available literature. Methods We searched PubMed, Scopus, and Cochrane Library through 31st December 2021, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Outcome metrics included operative time and intraoperative blood loss. Secondary outcomes consisted of length of hospital stay, length of drain stay, total drain output, and postoperative complications. A meta-analysis was conducted using Review Manager Version 5.3 (RevMan) software employing the Random Effects Model. Results We identified 114 articles, out of which 10 randomized control trials (RCTs) analyzing a combined total of 558 patients met the inclusion criteria after title and full-text screening. Meta-analysis shows the group treated with HS had a significantly shorter operative time. [MD = -23.21, 95% CI (-34.30, -12.12) P value <.0001 I2 = 92%] but an insignificant lesser intraoperative blood loss [MD = -61.53, 95% CI (-88.61, -34.45) P < .00001 I2 = 79%]. Conclusions This study confirms that that HS use in neck dissection yields a reduced operative time and intra operative blood loss relative to conventional hemostasis. Furthermore, our paper shows no superiority of HS method over conventional hemostasis where length of hospital stays, length of drain stays, and postoperative complications are concerned. Future RCTs with high-level evidence may further elucidate the relative effectiveness of HS method over conventional hemostasis in treating head and neck cancers.
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Affiliation(s)
- Ishaque Hameed
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Mohammad Omer Khan
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Syed Abdus Samad
- Department of Surgery, Dow University of Health Sciences, Karachi, Pakistan
| | - Samar Mahmood
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Omer Mustafa Siddiqui
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Indallah Hameed
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Muhammad Nashit
- Department of Surgery, Dow University of Health Sciences, Karachi, Pakistan
| | - Ayman Iqbal
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Shayan Marsia
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Al Haitham Al Shetawi
- Division of Oral and Maxillofacial Surgery, Vassar Brothers Medical Center, Poughkeepsie, NY, USA
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Vettoretto N, Foglia E, Gerardi C, Lettieri E, Nocco U, Botteri E, Bracale U, Caracino V, Carrano FM, Cassinotti E, Giovenzana M, Giuliani B, Iossa A, Milone M, Montori G, Peltrini R, Piatto G, Podda M, Sartori A, Allocati E, Ferrario L, Asperti F, Songia L, Garattini S, Agresta F. High-energy devices in different surgical settings: lessons learnt from a full health technology assessment report developed by SICE (Società Italiana di Chirurgia Endoscopica). Surg Endosc 2023; 37:2548-2565. [PMID: 36333498 PMCID: PMC9638482 DOI: 10.1007/s00464-022-09734-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The present paper aims at evaluating the potential benefits of high-energy devices (HEDs) in the Italian surgical practice, defining the comparative efficacy and safety profiles, as well as the potential economic and organizational advantages for hospitals and patients, with respect to standard monopolar or bipolar devices. METHODS A Health Technology Assessment was conducted in 2021 assuming the hospital perspective, comparing HEDs and standard monopolar/bipolar devices, within eleven surgical settings: appendectomy, hepatic resections, colorectal resections, cholecystectomy, splenectomy, hemorrhoidectomy, thyroidectomy, esophago-gastrectomy, breast surgery, adrenalectomy, and pancreatectomy. The nine EUnetHTA Core Model dimensions were deployed considering a multi-methods approach. Both qualitative and quantitative methods were used: (1) a systematic literature review for the definition of the comparative efficacy and safety data; (2) administration of qualitative questionnaires, completed by 23 healthcare professionals (according to 7-item Likert scale, ranging from - 3 to + 3); and (3) health-economics tools, useful for the economic evaluation of the clinical pathway and budget impact analysis, and for the definition of the organizational and accessibility advantages, in terms of time or procedures' savings. RESULTS The literature declared a decrease in operating time and length of stay in using HEDs in most surgical settings. While HEDs would lead to a marginal investment for the conduction of 178,619 surgeries on annual basis, their routinely implementation would generate significant organizational savings. A decrease equal to - 5.25/-9.02% of operating room time and to - 5.03/-30.73% of length of stay emerged. An advantage in accessibility to surgery could be hypothesized in a 9% of increase, due to the gaining in operatory slots. Professionals' perceptions crystallized and confirmed literature evidence, declaring a better safety and effectiveness profile. An improvement in both patients and caregivers' quality-of-life emerged. CONCLUSIONS The results have demonstrated the strategic relevance related to HEDs introduction, their economic sustainability, and feasibility, as well as the potentialities in process improvement.
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Affiliation(s)
- Nereo Vettoretto
- U.O.C. Chirurgia Generale, ASST Spedali Civili di Brescia P.O. Montichiari, Ospedale di Montichiari, Chirurgia, V.le Ciotti 154, 25018, Montichiari, BS, Italy.
| | - Emanuela Foglia
- Centre for Health Economics, Social and Health Care Management, Università Carlo Cattaneo - LIUC, Castellanza, Italy
| | - Chiara Gerardi
- Mario Negri Institute for Pharmacological Research IRCCS, Milan, Italy
| | - Emanuele Lettieri
- Dipartimento di Ingegneria Gestionale, Politecnico di Milano, Milan, Italy
| | - Umberto Nocco
- S.C. Ingegneria Clinica, ASST Grande Ospedale Metropolitano Niguarda and Associazione Italiana Ingegneri Clinici, Milan, Italy
| | - Emanuele Botteri
- U.O.C. Chirurgia Generale, ASST Spedali Civili di Brescia P.O. Montichiari, Ospedale di Montichiari, Chirurgia, V.le Ciotti 154, 25018, Montichiari, BS, Italy
| | - Umberto Bracale
- U.O.C. Chirurgie Generale e Oncologica Mini Invasiva, A.O.U. Policlinico Federico II, Naples, Italy
| | - Valerio Caracino
- U.O.C. Chirurgia Generale e d'Urgenza, AUSL Pescara, Pescara, Italy
| | | | - Elisa Cassinotti
- Chirurgia Generale, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Giovenzana
- Unit of HepatoBilioPancreatic and Digestive Surgery, Ospedale San Paolo, University of Milan, Milan, Italy
| | - Beatrice Giuliani
- Unit of HepatoBilioPancreatic and Digestive Surgery, Ospedale San Paolo, University of Milan, Milan, Italy
| | - Angelo Iossa
- Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, University of Rome Sapienza Polo Pontino, Rome, Italy
| | - Marco Milone
- U.O.C. Chirurgia Generale, Azienda Ospedaliera Universitaria Federico II di Napoli, Naples, Italy
| | - Giulia Montori
- U.O.C. Chirurgia Generale, Ospedale di Vittorio Veneto, Treviso, Italy
| | - Roberto Peltrini
- U.O.C. Chirurgie Generale e Oncologica Mini Invasiva, A.O.U. Policlinico Federico II, Naples, Italy
| | - Giacomo Piatto
- UOC Chirurgia Generale e d'Urgenza, Ospedale di Montebelluna (TV), AULSS 2 Marca Trevigiana, Treviso, Italy
| | - Mauro Podda
- Dipartimento di Scienze Chirurgiche, Università degli Studi di Cagliari, Cagliari, Italy
| | - Alberto Sartori
- UOC Chirurgia Generale e d'Urgenza, Ospedale di Montebelluna (TV), AULSS 2 Marca Trevigiana, Treviso, Italy
| | - Eleonora Allocati
- Mario Negri Institute for Pharmacological Research IRCCS, Milan, Italy
| | - Lucrezia Ferrario
- Centre for Health Economics, Social and Health Care Management, Università Carlo Cattaneo - LIUC, Castellanza, Italy
| | - Federica Asperti
- Centre for Health Economics, Social and Health Care Management, Università Carlo Cattaneo - LIUC, Castellanza, Italy
| | - Letizia Songia
- S.C. Ingegneria Clinica, ASST Grande Ospedale Metropolitano Niguarda and Associazione Italiana Ingegneri Clinici, Milan, Italy
- SC Ingengeria Clinica, ASST di Lecco, Lecco, Italy
| | - Silvio Garattini
- Centre for Health Economics, Social and Health Care Management, Università Carlo Cattaneo - LIUC, Castellanza, Italy
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Spartalis E, Giannakodimos A, Giannakodimos I, Ziogou A, Papasilekas T, Patelis N, Schizas D, Troupis T. The role of LigaSure™ and Harmonic Scalpel in the preservation of recurrent laryngeal nerve during thyroidectomy. Ann R Coll Surg Engl 2021; 104:324-329. [PMID: 34415202 DOI: 10.1308/rcsann.2021.0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Transient or permanent damage to the recurrent laryngeal nerve (RLN) during thyroidectomy is of paramount importance for patient quality of life. The aim of this study is to systematically review the literature concerning the role of the most popular energy-based vessel-sealing devices (LigaSure™ (LS) and Harmonic Scalpel (HS)) in preservation of the RLN during thyroidectomy. The safety and inferiority or superiority of LS and HS compared with conventional haemostatic techniques are highlighted. METHODS A systematic search of the literature was performed. Clinical trials, prospective and retrospective studies that significantly compared the use of LS and HS with conventional haemostasis regarding the postoperative incidence of RLN palsy were included. FINDINGS The search resulted in 43 studies, including 17,953 patients treated using energy-based devices or conventional haemostatic methods. Concerning the incidence of RLN palsy, 40 studies showed no significant difference between the energy-based device and conventional groups, whereas two studies demonstrated a significant superiority in performance for LS and HS compared with conventional haemostasis. Only one study exhibited significant inferiority of LS and HS compared with conventional methods. No statistical relationship was observed between energy-based devices and conventional techniques regarding permanent damage to the RLN. CONCLUSION The performance of both LS and HS shows no inferiority compared with conventional haemostatic techniques, regarding damage to the laryngeal nerve. Further well-designed studies are needed to investigate their potential benefit in preservation of the RLN.
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Affiliation(s)
- E Spartalis
- National and Kapodistrian University of Athens, Greece
| | | | | | - A Ziogou
- National and Kapodistrian University of Athens, Greece
| | - T Papasilekas
- National and Kapodistrian University of Athens, Greece
| | - N Patelis
- National and Kapodistrian University of Athens, Greece
| | - D Schizas
- National and Kapodistrian University of Athens, Greece
| | - T Troupis
- National and Kapodistrian University of Athens, Greece
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Spartalis E, Giannakodimos A, Ziogou A, Giannakodimos I, Paschou SA, Spartalis M, Schizas D, Troupis T. Effect of energy-based devices on post-operative parathyroid function and blood calcium levels after total thyroidectomy. Expert Rev Med Devices 2021; 18:291-298. [PMID: 33666537 DOI: 10.1080/17434440.2021.1899805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Introduction: Energy-based devices are widely used in thyroid surgery in order to achieve optimal hemostasis, while their role in the incidence of hypocalcemia and hypoparathyroidism comprises a topic evaluated in numerous studies.Areas covered: The aim of this systematic review is to investigate the potential benefit of Ultrasonic Shears and Electrothermal Bipolar (Radiofrequency) System in thyroid surgery regarding the incidence of post-operative hypocalcemia and hypoparathyroidism. A systematic review of the literature in PubMed/Medline and Scopus databases was conducted. Forty-nine studies met the inclusion criteria and were analyzed. A statistically decreased rate of transient hypocalcemia and hypoparathyroidism was reported in 15 studies and 4 studies, respectively, when using energy-based devices. However, 18 and 13 surveys examined transient hypocalcemia and hypoparathyroidism, respectively, and demonstrated no statistical difference between energy-based devices and conventional hemostasis. No difference was observed between the groups concerning permanent hypocalcemia. Out of 13 studies, only 2 showed a significant reduction in the occurrence of permanent hypoparathyroidism in the energy-based device group.Expert opinion: Energy-based devices reduced the rate of transient hypocalcemia and hypoparathyroidism after thyroid surgeries in 42.8% and 23.5% of the included studies, respectively. Further studies are needed to evaluate their impact on permanent post-operative hypocalcemia and hypoparathyroidism.
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Affiliation(s)
- Eleftherios Spartalis
- 2nd Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Medical School, Athens, Greece.,Laboratory of Experimental Surgery and Surgical Research "N.S Christeas," National and Kapodistrian University of Athens, Medical School, Athens, Greece.,Department of Anatomy, Medical School, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Alexios Giannakodimos
- 2 Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Afroditi Ziogou
- Third Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Ilias Giannakodimos
- 1st Department of Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavroula A Paschou
- Division of Endocrinology, Diabetes and Metabolism, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Michael Spartalis
- Laboratory of Experimental Surgery and Surgical Research "N.S Christeas," National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Dimitrios Schizas
- 1st Department of Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodore Troupis
- Department of Anatomy, Medical School, National and Kapodistrian University of Athens, Medical School, Athens, Greece
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Huang TY, Lin YC, Tseng HY, Dionigi G, Kim HY, Lu IC, Chang PY, Chiang FY, Wu CW. Safety of Ligasure exact dissector in thyroidectomy with continuous neuromonitoring: a porcine model. Gland Surg 2020; 9:702-710. [PMID: 32775260 DOI: 10.21037/gs.2020.03.17] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The purpose of this study was to investigate and define safety parameters for using the Ligasure exact dissector (LED) for dissection close to the recurrent laryngeal nerve (RLN) during thyroidectomy. Methods Real-time electrophysiologic electromyographic (EMG) tracings were recorded in 16 RLNs (8 piglets) during various applications of LED under continuous intraoperative monitoring in this prospective porcine model study. In the activation study, LED was activated at varying distances from the RLN. In the cooling study, LED was activated with different cooling times or after touching the sternocleidomastoid muscle before application to the RLN. Results In the activation study, no adverse EMG events occurred at distances longer than 1 mm. In the cooling study, no adverse EMG events occurred after a 2-second cooling time. Additionally, no adverse EMG events occurred when a sternocleidomastoid muscle touch maneuver was used for cooling. Conclusions The LED can be safely used at distance of 1 mm or longer, and it should be cooled for at least 2 seconds or by muscle touch maneuver. Thyroid surgeons can avoid RLN injury if standard procedures for LED use are observed.
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Affiliation(s)
- Tzu-Yen Huang
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan
| | - Yi-Chu Lin
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsin-Yi Tseng
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Gianlorenzo Dionigi
- Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood "Gaetano Barresi", University Hospital G. Martino, University of Messina, Messina, Italy
| | - Hoon-Yub Kim
- Department of Surgery, KUMC Thyroid Center, Korea University Hospital, Korea University College of Medicine, Seoul, Korea
| | - I-Cheng Lu
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pi-Ying Chang
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Feng-Yu Chiang
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan.,Department of Otolaryngology, E-Da Hospital, Kaohsiung, Taiwan
| | - Che-Wei Wu
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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7
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Konishi T, Fujiogi M, Niwa T, Morita K, Matsui H, Fushimi K, Tanabe M, Seto Y, Yasunaga H. Comparison of outcomes after differentiated thyroid cancer surgery performed with and without energy devices: A population-based cohort study using a nationwide database in Japan. Int J Surg 2020; 77:198-204. [DOI: 10.1016/j.ijsu.2020.03.072] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/06/2020] [Accepted: 03/27/2020] [Indexed: 11/25/2022]
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Siu JM, McCarty JC, Gadkaree S, Caterson EJ, Randolph G, Witterick IJ, Eskander A, Bergmark RW. Association of Vessel-Sealant Devices vs Conventional Hemostasis With Postoperative Neck Hematoma After Thyroid Operations. JAMA Surg 2019; 154:e193146. [PMID: 31532475 DOI: 10.1001/jamasurg.2019.3146] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Importance Vessel-sealant devices (VSDs) have been popularized for use in thyroid operations; however, the association of their use with postoperative neck hematoma, a rare but potentially fatal complication, has not been well studied. Objective To examine the association of VSDs vs conventional hemostasis (CH) in thyroid operations with the development of neck hematoma. Design, Setting, and Participants This retrospective cohort study evaluated 10 903 patients in the Thyroid Procedure-Targeted Database of the National Surgical Quality Improvement Program from January 1, 2016, to December 31, 2017. One-to-one nearest-neighbor propensity score matching was conducted to adjust for differences in baseline covariates, including demographics, comorbidities, indications for thyroid procedure (goiter, Graves disease, malignant and benign thyroid nodule), and several other thyroid-specific characteristics, between the VSD and CH groups. Main Outcomes and Measures The primary outcome was postoperative hematoma requiring intervention with open evacuation, return to the operating room, tracheostomy, additional observation, or extended length of stay. Secondary outcomes include recurrent laryngeal nerve injury, operative duration, and hospital length of stay. Results One-to-one propensity score matching yielded 6522 patients (mean [SD] age, 52 [15] years; 8544 [78.4%] female) with 3261 in each exposure group such that distribution of observed baseline covariates was not different between groups of the same propensity score. Within the matched cohort, CH was associated with higher odds of neck hematoma compared with VSD (odds ratio, 2.33; 95% CI, 1.55-3.49; P < .001), with 34 (1.0%) hematomas in the VSD group and 78 (2.4%) in the CH group. On the basis of this analysis, the number needed to treat with a VSD to prevent 1 postoperative hematoma was 74. Secondary outcomes included longer length of hospital stay (incidence rate ratio, 1.29; 95% CI, 1.23-1.36; P < .001]) in the CH group compared with the VSD group but no difference in the odds of recurrent laryngeal nerve injury (odds ratio, 0.90; 95% CI, 0.73-1.11; P = .32) or operative duration (incidence rate ratio, 0.99; 95% CI, 0.96-1.01; P = .24). Conclusions and Relevance Use of VSDs during thyroid operations was associated with reduced odds of neck hematoma compared with CH techniques without increasing odds of nerve injury. The results suggest that postoperative neck hematoma rates after thyroid surgery may differ based on the hemostasis technique and that these differences should be considered when developing strategies for quality improvement of postoperative outcomes.
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Affiliation(s)
- Jennifer M Siu
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Justin C McCarty
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts.,Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Shekhar Gadkaree
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston.,Department of Otolaryngology-Head & Neck Surgery, Harvard Medical School, Boston, Massachusetts
| | - Edward J Caterson
- Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Gregory Randolph
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston.,Department of Otolaryngology-Head & Neck Surgery, Harvard Medical School, Boston, Massachusetts
| | - Ian J Witterick
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Antoine Eskander
- Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head & Neck Surgery, Surgical Oncology, University of Toronto, Sunnybrook Health Sciences Centre and Michael Garron Hospital, Toronto, Ontario, Canada
| | - Regan W Bergmark
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Otolaryngology-Head & Neck Surgery, Harvard Medical School, Boston, Massachusetts.,Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, Massachusetts
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Kadem SG, Alabbood MH. Safety and Efficacy of Bipolar Radiofrequency Ablation Device in Hemostasis during Thyroidectomy in Comparison with Ultrasonic Scalpel: A Comparative Study. Indian J Endocrinol Metab 2019; 23:76-80. [PMID: 31016158 PMCID: PMC6446675 DOI: 10.4103/ijem.ijem_519_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
AIM Ultrasonic scalpel is one of the recent advances in surgical technology. The main limitation of their use is the cost. However, radiofrequency ablation device is a refined type of electrosurgical cautery that can be used with conventional reusable bipolar cautery forceps. This study aims to compare the efficacy of bipolar radiofrequency ablation device that can be used with conventional reusable bipolar cautery forceps for hemostasis and dissection during thyroidectomy with that of ultrasonic scalpel. MATERIALS AND METHODS Sixty patients underwent total thyroidectomy were recruited at Alshiffa General Hospital, Basrah, Iraq from March 2016 to June 2017. The participants were divided into two equal groups: in the first group thyroid dissection was done with ultrasonic scalpel, and in the second group thyroid dissection was done with bipolar radiofrequency ablation device. Outcome and complications of both procedures were analyzed statistically and compared. RESULTS The bipolar radiofrequency ablation device significantly reduced the mean operative time by (-15.35 min) in comparison to ultrasonic scalpel. The Bipolar Radiofrequency Ablation Device (BRFA) group reported a mean operative time of 50.13 ± 14.16 compared to 65.49 ± 7.78 in the US group with, P value = 0.001. There was no statistically significant difference in the other outcome parameters and the rate of complications reported between the two devices during this study. CONCLUSION The bipolar radiofrequency ablation device that can be used with conventional reusable bipolar cautery forceps is a simple, safe, and time-saving adjunct for thyroid surgeries and equally effective as compared to costly instruments like ultrasonic scalpel. CLINICAL SIGNIFICANCE The bipolar radiofrequency device can be used in thyroid surgery to secure hemostasis, save time, and cost.
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Affiliation(s)
- Sadeq G. Kadem
- Department of Surgery, Al-Shiffa General Hospital, Basra, Iraq
| | - Majid H. Alabbood
- The Specialized Endocrine and Diabetes Center, Al-Mawani Teaching Hospital, Basra, Iraq
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Aires FT, Matos LLD, Dedivitis RA, Cernea CR. Effectiveness of harmonic scalpel in patients submitted to total thyroidectomy: systematic review with meta-analysis. Rev Assoc Med Bras (1992) 2018; 64:649-657. [DOI: 10.1590/1806-9282.64.07.649] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 12/06/2017] [Indexed: 11/22/2022] Open
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Kim HK, Chai YJ, Lee HY, Kim HY, Dionigi G. Comparing the safety of harmonic ACE and ACE+ around the recurrent laryngeal nerve in swine models. Ann Surg Treat Res 2018; 94:285-290. [PMID: 29854705 PMCID: PMC5976568 DOI: 10.4174/astr.2018.94.6.285] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 10/13/2017] [Accepted: 10/23/2017] [Indexed: 11/30/2022] Open
Abstract
Purpose Among the various energy-based devices, ultrasonic shears are popular in thyroid surgeries. In this study, we tested the safety of Harmonic ACE and Harmonic ACE+ around the recurrent laryngeal nerve (RLN) in experimental swine models. Methods Harmonic ACE and Harmonic ACE+ were each tested in 4 piglets. Harmonic ACE and Harmonic ACE+ were activated at a 0- to 5-mm distance from the RLN. The function of the RLN was assessed using continuous electrophysiological monitoring. Results For Harmonic ACE, there was no adverse EMG event found when activated at 4- and 5-mm distances from the RLN. At a 2- to 3-mm distance, there were 4 adverse EMG events observed. In these 4 cases, adjacent tissue shrinkage occurred after 6 to 15 seconds of activation, and the RLN touched the Harmonic ACE. At a 1-mm distance, there were 2 adverse EMG events found after 25 seconds of activation. For Harmonic ACE+, there was no adverse EMG event observed when activated at 1- and 3-mm distances from the RLN. At a 0-mm distance, 2 adverse EMG events occurred after 6 to 10 seconds of activation. Conclusion The safe distance of Harmonic ACE and ACE+ was 4 and 1 mm, respectively, in the swine models. Harmonic ACE+ is safer than Harmonic ACE because it did not cause any tissue shrinkage. Surgeons need to understand the characteristics of devices for safe operation.
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Affiliation(s)
- Hong Kyu Kim
- Department of Surgery, KUMC Thyroid Center, Korea University Hospital, Korea University College of Medicine, Seoul, Korea
| | - Young Jun Chai
- Department of Surgery, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul, Korea
| | - Hye Yoon Lee
- Department of Surgery, KUMC Thyroid Center, Korea University Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hoon Yub Kim
- Department of Surgery, KUMC Thyroid Center, Korea University Hospital, Korea University College of Medicine, Seoul, Korea
| | - Gianlorenzo Dionigi
- Division for Endocrine Surgery, Department of Human Pathology in Adulthood and Childhood "G. Barresi," University Hospital G. Martino, University of Messina, Messina, Italy
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12
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Intra-capsular total thyroid enucleation versus total thyroidectomy in treatment of benign multinodular goiter. A prospective randomized controlled clinical trial. Int J Surg 2017; 45:29-34. [PMID: 28728986 DOI: 10.1016/j.ijsu.2017.07.074] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 07/12/2017] [Accepted: 07/15/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Due to high recurrence rate after subtotal thyroidectomy, most of centers have shifted to total thyroidectomy as a surgical treatment for benign multinodular goiter (BMNG), but serious complications, as laryngeal nerve affection & hypocalcaemia, are still present. This study aimed to evaluate treatment of BMNG using intra-capsular total thyroid enucleation in comparison to standard total thyroidectomy. PATIENTS &METHODS This is a prospective randomized controlled clinical trial conducted in a hospital in the period from December 2009 to December 2015. Of total 224 patients with clinically BMNG. 112 patients operated by intracapsular total thyroid enucleation (ITTE group) and the other 112 patients operated by standard total thyroidectomy (STT group). The minimal follow up period was 36 months. RESULTS The mean operative time in ITTE group was (93.7 ± 9.6 min) compared to (86.9 ± 8.3 min) in STT group. Transient recurrent laryngeal nerve (RLN) palsy was 0% in ITTE group VS 7.1% in STT group. No cases (0%) developed permanent RLN palsy in ITTE group VS 0.9% in STT group. Symptomatic transient hypocalcaemia occurred in 1.8% in ITTE group VS 11.6% in STT group. No cases (0%) developed permanent hypocalcaemia in ITTE group VS 0.9% in STT group. No recurrence (0%) in both groups after minimal 3 years of follow up. CONCLUSION Intracapsular Total thyroid enucleation technique is safe with the least serious complications, especially RLN injury and hypoparathyroidism, with no recurrence, but this technique still not radical so couldn't be used in suspicious cases for malignancy.
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Blanchard C, Pattou F, Brunaud L, Hamy A, Dahan M, Mathonnet M, Volteau C, Caillard C, Durand-Zaleski I, Mirallié E. Randomized clinical trial of ultrasonic scissors versus conventional haemostasis to compare complications and economics after total thyroidectomy (FOThyr). BJS Open 2017; 1:2-10. [PMID: 29951599 PMCID: PMC5989994 DOI: 10.1002/bjs5.2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 03/16/2017] [Indexed: 11/26/2022] Open
Abstract
Background The benefits of single‐use ultrasonic scissors in thyroid surgery are still debated. Although this device has been shown to reduce operating time compared with conventional haemostasis, its cost‐effectiveness has never been demonstrated. The aim of this study was to evaluate the efficacy, cost‐effectiveness and safety of ultrasonic scissors for total thyroidectomy. Methods This was a prospective, randomized, multicentre trial conducted at 13 hospital sites. The primary endpoint was the percentage of patients with hypocalcaemia (serum calcium level below 2 mmol/l) on day 2. Secondary endpoints included postoperative complications and costs, with calculation of incremental cost differences and cost‐effectiveness ratios. Results In total, 1329 patients who underwent total thyroidectomy were included in the analysis: 670 were randomized to treatment with ultrasonic scissors and 659 to conventional haemostasis. There was no difference between groups in the rate of complications, including hypocalcaemia on day 2 (19.7 per cent in ultrasonic scissors group versus 20.3 per cent in conventional haemostasis group; P = 0·743). Median operating times were significantly shorter with ultrasonic scissors (90 versus 100 min with conventional haemostasis; P < 0·001). Total mean(s.d.) direct costs at 6 months were €4311(1547) and €4011(1596) respectively (P < 0·001). Conclusion Ultrasonic scissors were no more clinically effective than conventional haemostasis, but use of these devices was more costly. Registration number: NCT01551914 (http://www.clinicaltrials.gov).
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Affiliation(s)
- C Blanchard
- Clinique de Chirurgie Digestive et Endocrinienne Centre Hospitalier Universitaire (CHU) de Nantes Nantes France
| | - F Pattou
- Chirurgie Générale et Endocrinienne, CHU Lille Université de Lille Lille France
| | - L Brunaud
- Service de Chirurgie Digestive, Hépato-Biliaire et Endocrinienne CHU Nancy - Hôpital de Brabois Nancy France
| | - A Hamy
- Chirurgie Digestive et Endocrinienne CHU Angers Angers France
| | - M Dahan
- Chirurgie Thoracique, Pôle Voies Respiratoires CHU de Toulouse - Hôpital Larrey Toulouse France
| | - M Mathonnet
- Chirurgie Digestive, Générale et Endocrinienne CHU de Limoges - Hôpital Dupuytren Limoges France
| | - C Volteau
- Département Promotion Délégation à la Recherche Clinique et à l'Innovation Nantes France
| | - C Caillard
- Clinique de Chirurgie Digestive et Endocrinienne Centre Hospitalier Universitaire (CHU) de Nantes Nantes France
| | - I Durand-Zaleski
- Assistance Publique - Hôpitaux de Paris Unité de Recherche Clinique en Économie de la Santé d'Île-de-France Hôpital de l'Hôtel-Dieu Paris France
| | - E Mirallié
- Clinique de Chirurgie Digestive et Endocrinienne Centre Hospitalier Universitaire (CHU) de Nantes Nantes France
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Neagoe RM, Cvasciuc IT, Muresan M, Sala DT. INCIDENTAL PARATHYROIDECTOMY DURING THYROID SURGERY - RISK, PREVENTION AND CONTROVERSIES; AN EVIDENCE-BASED REVIEW. ACTA ENDOCRINOLOGICA-BUCHAREST 2017; 13:467-475. [PMID: 31149218 DOI: 10.4183/aeb.2017.467] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Postoperative hypocalcemia after thyroid surgery has a high prevalence ( 16-55% in different series). Incidental parathyroidectomy (IP) is a less discussed complication of thyroidectomy with consequences not properly defined. The aim of our study was to find incidence, risk factors and how to prevent IP. Methods Extensive search of English literature publications via PubMed was performed and 73 papers from 1980 to 2017 were analysed using the GRADE system/classification, quality of evidence was classified as "strong" when the result is highly unlikely to change existing recommendation and "weak" when opposite. Results Incidence of IP is 3.7-24.9%, while prevalence of permanent hypoparathyroidism is less frequent 6-12%. Direct relation between IP and hypoparathyroidism/hypocalcemia remains controversial. Female patients, ectopic parathyroids, small thyroids, Graves', malignancy, redo surgeries and total thyroidectomy favour IP. Routine visualization of parathyroids, new hemostatic devices, magnifying instruments and fluorescence can prevent incidental removal of parathyroids. Incidence of IP during videoassisted or robotic thyroidectomies was similar to open procedures. High volume, experienced and younger surgeons have lower complication rates (including hypoparathyroidism). Conclusions Incidental parathyroidectomy is more frequent than we might have expected. It should be avoided and parathyroid glands should be kept in situ. Majority of studies are retrospective (low degree of evidence according to previous mentioned GRADE classification) and further meta-analysis or randomized control studies are welcome in order to define the impact of incidental removal of parathyroids on postoperative outcome.
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Affiliation(s)
- R M Neagoe
- University of Medicine and Pharmacy, Second Department of Surgery, Targu Mures, Romania
| | - I T Cvasciuc
- Leeds Teaching Hospitals, Dept. of Endocrine Surgery, Leeds, United Kingdom of Great Britain and Northern Ireland
| | - M Muresan
- University of Medicine and Pharmacy, General Surgery, Targu Mures, Romania
| | - D T Sala
- Emergency Mures County Hospital, Second Department of Surgery, Targu Mures, Romania
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15
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Advanced vessel sealing devices in total thyroidectomy for substernal goitre: A retrospective cohort study. Int J Surg 2016; 35:160-164. [DOI: 10.1016/j.ijsu.2016.09.092] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/31/2016] [Accepted: 09/24/2016] [Indexed: 02/03/2023]
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16
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The Use of Harmonic Scalpel in Open Thyroid Surgery: Is It Rewarding? Int Surg 2016. [DOI: 10.9738/intsurg-d-16-00140.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The advantages and effectiveness of the harmonic scalpel (HS) in open thyroid surgery were evaluated. Haemostasis is the most important factor for successful thyroid surgery. Our aim was to compare the effect of the use of harmonic scalpel versus the conventional haemostasis (CH) methods during open thyroidectomy in the intra-operative and postoperative outcomes. A retrospective review of all total thyroidectomy operations performed in six years was done. The patients were divided in two groups: the CH group and the HS group according to the method used. Information regarding patient's age and sex, pathological diagnosis, operations details, operations duration, the blood loss, the use of drains, and the complications were recorded. Out of 239 operations performed, 143 operations were in the CH group and 96 operations were in the HS group. The average duration of operation was 73 minutes in the HS group versus 97 minutes in the CH group (P < 0.005). Blood loss was less in the HS group (P = 0.014), with fewer drains (P < 0.005). Transient hypocalcaemia (TH) was less in the HS group (12.5% vs. 25.9%, P = 0.012). The hospital stay was less in the HS group (3.4 days vs. 3.9 days, P = 0.001). The use of HS was more costly. HS use in thyroid surgery reduces: operation time, blood loss, use of drains, postoperative TH, and shortens hospital stay. It is more costly but the advantages of its use in a busy hospital offset this drawback.
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A comparison of surgical outcomes and complications between hemostatic devices for thyroid surgery: a network meta-analysis. Eur Arch Otorhinolaryngol 2016; 274:1269-1278. [DOI: 10.1007/s00405-016-4190-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 06/28/2016] [Indexed: 11/25/2022]
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18
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Cannizzaro MA, Borzì L, Lo Bianco S, Okatyeva V, Cavallaro A, Buffone A. Comparison between Focus Harmonic scalpel and other hemostatic techniques in open thyroidectomy: A systematic review and meta-analysis. Head Neck 2016; 38:1571-8. [PMID: 27224745 DOI: 10.1002/hed.24449] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 01/18/2016] [Accepted: 02/09/2016] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The purpose of this review was to compare the efficacy and surgical outcomes of total thyroidectomy between the Focus Harmonic scalpel (Ethicon, Cincinnati, OH) and other hemostatic procedures. METHODS An extensive search was conducted using the PubMed and Cochrane databases from January 2008 to October 2014. Operating time, blood loss, pain, complications, and hospital stay were evaluated. RESULTS When compared with conventional techniques or LigaSure Precise Vessel Sealing System (Medtronic, Minneapolis, MN), the use of the Focus Harmonic scalpel reduced operative time by 22,428 minutes and blood loss by 13,914 mL. Length of hospital stay was significantly shorter in the Focus Harmonic scalpel group with a mean reduction of 0.410 days. CONCLUSION According to our meta-analysis, when comparing the Focus Harmonic scalpel versus conventional techniques, it seems evident that the use of this device in thyroid surgery is associated with a mean reduction in operating time, blood loss, and hospital stay, without any increase in pain and complications. There was no appreciable difference between the Focus Harmonic scalpel and the LigaSure Precise Vessel Sealing System. © 2016 Wiley Periodicals, Inc. Head Neck 38: First-1578, 2016.
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Affiliation(s)
- Matteo Angelo Cannizzaro
- Department of "Scienze Mediche, Chirurgiche e tecnologie Avanzate - G. F. Ingrassia", University of Catania, Endocrine Surgery Unit, "Policlinico-Vittorio Emanuele" Hospital, Catania, Italy.
| | - Laura Borzì
- Department of General Surgery and Senology Unit, "Policlinico-Vittorio Emanuele" Hospital, Catania, Italy
| | - Salvatore Lo Bianco
- Department of Endocrine Surgery, "Policlinico-Vittorio Emanuele" Hospital, Catania, Italy
| | - Valeriya Okatyeva
- Department of Endocrine Surgery, "Policlinico-Vittorio Emanuele" Hospital, Catania, Italy
| | - Andrea Cavallaro
- Department of General Surgery and Senology Unit, "Policlinico-Vittorio Emanuele" Hospital, Catania, Italy
| | - Antonino Buffone
- Department of Endocrine Surgery, "Policlinico-Vittorio Emanuele" Hospital, Catania, Italy
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Total thyroidectomy: Conventional Suture Ligation technique versus sutureless techniques using Harmonic Scalpel or Maxium. Ann Med Surg (Lond) 2016; 5:29-34. [PMID: 26858831 PMCID: PMC4706571 DOI: 10.1016/j.amsu.2015.11.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 11/22/2015] [Accepted: 11/23/2015] [Indexed: 11/20/2022] Open
Abstract
Objectives Harmonic Scalpel (HS) and Maxium (MAX) are surgical shears that enable simultaneous vessel sealing and tissue coagulation. This study compares the outcome of Total Thyroidectomy (TT) using Conventional Suture Ligation (CSL) technique versus (vs) two sutureless techniques; H S and MAX techniques in terms of safety, operative time, blood drainage volume, hospital stay and surgical complications. Study design This is a prospective observational cohort study. Setting This study was performed in AL-Karama Teaching Hospital/College of Medicine/University of Wasit/Iraq. Patients and methods This study was performed from June 2012 to 2015. A total of 80 patients, 60 patients were females and 20 patients were males (average/mean of age was 39/38 years). They underwent TT after been randomized into the following three groups: CSL group when Suture Ligation Technique was used, HS group when Harmonic Scalpel was used and MAX group when bipolar electrosurgery Maxium was used. Results The postoperative evaluation of operative time, blood drainage volume and surgical complications revealed no statistically significant differences between HS group & MAX group, but there were statistically significant differences between CSL group vs. HS and MAX groups. Operative time statistics showed significant differences between CSL vs. HS and MAX groups, 113 ± 10.9 minutes (min), 93 ± 13 min and 92 ± 10.6 min respectively, p-value < 0.001 and 95% confidence interval [CI] (92.3712, 101.6288). The postoperative blood drainage volumes were significantly different between the three groups: CSL group = 150 ± 12.7 ml, HS group = 89 ± 16.21 ml and MAX group = 118 ± 9.6 ml, P-value = 0.046 and 95% [CI] (89.9932, 99.6068). Conclusions HS and MAX are safe, effective, and time-saving techniques. They are also associated with low blood loss and low complication rates. HS and MAX are good alternative techniques to CSL for thyroid surgery. HS and MAX are safe useful and fast alternatives to conventional techniques in total thyroidectomy. These two devices facilitate surgical procedures and cancel any need for clips and suture ligations. They significantly reduce operative time without increases in the amount of blood losses and hospital stay. Probably the only disadvantage of these two devices is the cost of the single-use devices.
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Kwak HY, Dionigi G, Kim D, Lee HY, Son GS, Lee JB, Bae JW, Kim HY. Thermal injury of the recurrent laryngeal nerve by THUNDERBEAT during thyroid surgery: findings from continuous intraoperative neuromonitoring in a porcine model. J Surg Res 2016; 200:177-82. [DOI: 10.1016/j.jss.2015.06.066] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 06/02/2015] [Accepted: 06/26/2015] [Indexed: 11/29/2022]
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Cheng H, Soleas I, Ferko NC, Clymer JW, Amaral JF. A systematic review and meta-analysis of Harmonic Focus in thyroidectomy compared to conventional techniques. Thyroid Res 2015; 8:15. [PMID: 26430471 PMCID: PMC4589949 DOI: 10.1186/s13044-015-0027-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 09/21/2015] [Indexed: 11/16/2022] Open
Abstract
Introduction Several meta-analyses have been performed comparing the use of a variety of ultrasonic devices in thyroidectomy to conventional procedures. These studies have shown the superiority of ultrasonic devices for most outcomes studied including faster operative time and less blood loss, and equivalent or better safety for recurrent laryngeal nerve paresis and hypocalcemia. The current work is the first to examine a single ultrasonic device specifically designed for thyroid surgery, the Harmonic Focus, in order to confirm its efficacy and safety in thyroidectomy. Methods A comprehensive literature search without language restrictions was performed for randomized clinical trials comparing Harmonic Focus and conventional clamp, cut and tie in thyroidectomy. Outcome measures included operating time, blood loss, post-operative pain, length of hospital stay, hypocalcemia and recurrent laryngeal nerve paresis. Risk of bias was analyzed for all studies. Meta-analysis was performed using random effects models with the inverse-variance method for mean differences of continuous variables and the Mantel-Haenszel method for risk ratios of dichotomous variables. Results A total of 14 studies met the inclusion criteria. Harmonic Focus reduced operative time by 29 min, a 31 % decrease (p < 0.001), intra-operative blood loss by 45 ml (p < 0.001), post-operative pain (p < 0.001), length of hospital stay by 0.68 days (p = 0.005), drainage volume by 29 ml (p = 0.01), and occurrence of transient hypocalcemia by 40 % (p = 0.001). There were no significant differences between Harmonic Focus and conventional procedures in rate of persistent hypocalcemia, or rates of transient and persistent recurrent laryngeal nerve paresis. Conclusion This is the first meta-analysis of Harmonic Focus in thyroid surgery. In agreement with meta-analyses previously performed on ultrasonic devices, use of the Harmonic Focus has been shown to be a more effective surgical procedure compared to conventional methods in thyroidectomy. The low occurrence of hypocalcemia and recurrent laryngeal nerve paresis confirms that Harmonic Focus can improve thyroidectomy efficiency without increasing the risk of complications.
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Affiliation(s)
- Hang Cheng
- Ethicon Inc, 4545 Creek Rd, Cincinnati, OH 45242 USA
| | - Ireena Soleas
- Cornerstone Research Group, 204-3228 South Service Road, Burlington, ON L7N 3H8 Canada
| | - Nicole C Ferko
- Cornerstone Research Group, 204-3228 South Service Road, Burlington, ON L7N 3H8 Canada
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Docimo G, Tolone S, Conzo G, Limongelli P, Del Genio G, Parmeggiani D, De Palma M, Lupone G, Avenia N, Lucchini R, Monacelli M, Gulotta G, Scerrino G, Pasquali D, Bellastella G, Esposito K, De Bellis A, Pezzolla A, Ruggiero R, Docimo L. A Gelatin-Thrombin Matrix Topical Hemostatic Agent (Floseal) in Combination With Harmonic Scalpel Is Effective in Patients Undergoing Total Thyroidectomy: A Prospective, Multicenter, Single-Blind, Randomized Controlled Trial. Surg Innov 2015; 23:23-9. [PMID: 26243629 DOI: 10.1177/1553350615596638] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Hemostasis during thyroidectomy is essential; however, the safest, most efficient, and most cost-effective way to achieve this is unclear. This randomized, multicenter, single-blind, prospective study evaluated the efficacy and safety of using different hemostatic approaches in patients undergoing total thyroidectomy. METHODS Patients aged ≥18 to 70 years were randomized to Floseal + a harmonic scalpel (HS), Floseal alone, HS alone, or standard total thyroidectomy. Primary endpoint was 24-hour drain output. Secondary endpoints included surgery duration and complications. RESULTS Two hundred and six patients were randomized to Floseal + HS (n = 52), Floseal alone (n = 54), HS alone (n = 50), and standard total thyroidectomy (n = 50). The 24-hour drain output was lower in the Floseal + HS group compared with standard thyroidectomy. Floseal + HS also had a shorter surgery time (P < .0001) versus the other 3 treatments. CONCLUSION Floseal + HS can be effective at reducing postsurgical drain output and provides a complementary hemostatic approach in patients undergoing total thyroidectomy.
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Hahn CH, Trolle W, Sørensen CH. Harmonic focus in thyroidectomy for substernal goiter. Auris Nasus Larynx 2015; 42:311-7. [DOI: 10.1016/j.anl.2014.12.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 12/06/2014] [Accepted: 12/29/2014] [Indexed: 11/30/2022]
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24
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Wu CW, Chai YJ, Dionigi G, Chiang FY, Liu X, Sun H, Randolph GW, Tufano RP, Kim HY. Recurrent laryngeal nerve safety parameters of the Harmonic Focus during thyroid surgery: Porcine model using continuous monitoring. Laryngoscope 2015. [PMID: 26198968 DOI: 10.1002/lary.25412] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES/HYPOTHESIS The Harmonic Focus (HF) is one of the most popular energy-based devices. The aim of this study was to provide recurrent laryngeal nerve (RLN) functional data that define the safety parameters of the HF during thyroidectomy. STUDY DESIGN Prospective porcine model using continuous electrophysiologic monitoring. METHODS Ten piglets were used. At varying distances from the RLN, the HF was activated (activation study). The HF was also applied directly on the RLN after activation on sternocleidomastoid muscle for 10 seconds with different cooling times (cooling study). RESULTS In the activation study, there was no adverse electromyography (EMG) event at more than 1 mm distance. In the cooling study, there was no adverse EMG event after a 10-second cooling period. When the HF was cooled on the sternocleidomastoid muscle, there was no adverse EMG event after 2 seconds cooling time. CONCLUSIONS The safe distance of the HF was 1 mm, and it should be cooled for more than 10 seconds or 2 seconds after cooling on muscle. The HF should be used in a standardized manner to avoid RLN injury. LEVEL OF EVIDENCE NA.
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Affiliation(s)
- Che-Wei Wu
- Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Young Jun Chai
- Department of Surgery, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Gianlorenzo Dionigi
- Endocrine Surgery Research Center, Department of Surgical Sciences, University of Insubria, Varese-Como, Varese, Italy
| | - Feng-Yu Chiang
- Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Xiaoli Liu
- Department of Thyroid and Parathyroid Surgery, China-Japan Union Hospital, Jilin University & Jilin Provincial Key Laboratory of Surgical Translational Medicine, Changchun, Jilin, China
| | - Hui Sun
- Department of Thyroid and Parathyroid Surgery, China-Japan Union Hospital, Jilin University & Jilin Provincial Key Laboratory of Surgical Translational Medicine, Changchun, Jilin, China
| | - Gregory W Randolph
- Division of Thyroid and Parathyroid Surgery, Department of Laryngology and Otology, Massachusetts Eye and Ear Infirmary, Harvard Medical School.,Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Ralph P Tufano
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
| | - Hoon Yub Kim
- Department of Surgery, KUMC Thyroid Center, Korea University Hospital, Korea University College of Medicine, Seoul, Korea
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The role of ultrasonic instruments in pharyngolaryngeal endoscopic surgery. Eur Arch Otorhinolaryngol 2015; 272:2551-5. [DOI: 10.1007/s00405-015-3570-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 02/18/2015] [Indexed: 10/23/2022]
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Antakia R, Edafe O, Uttley L, Balasubramanian SP. Effectiveness of preventative and other surgical measures on hypocalcemia following bilateral thyroid surgery: a systematic review and meta-analysis. Thyroid 2015; 25:95-106. [PMID: 25203484 DOI: 10.1089/thy.2014.0101] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND A variety of measures have been proposed to reduce the incidence of post-thyroidectomy hypocalcemia. The aim of this study was to perform a systematic review and meta-analysis of preventive and other surgical measures on post-thyroidectomy hypocalcemia as reported in the literature. METHODS Comprehensive searches of the PubMed, EMBASE, and Cochrane databases were performed, and the quality of included papers was assessed using the Cochrane risk of bias tool or a modified Newcastle-Ottawa Scale (NOS). The results of all included studies were summarized, and meta-analyses were performed where appropriate. RESULTS Thirty-nine randomized controlled trials (RCTs) and 37 observational studies were included. Measures studied included hemostatic techniques, extent of thyroidectomy and central neck dissection, surgical approach, calcium/vitamin D/thiazide diuretic supplements, parathyroid gland autotransplantation (PGAT) and intraoperative parathyroid gland (PG) identification, truncal ligation of inferior thyroid artery (ITA), preoperative magnesium infusion, and use of magnification loupes and Surgicel. Measures associated with significantly lower rates of transient hypocalcemia in meta-analysis were postoperative calcium and vitamin D supplementation compared to either calcium supplements alone (odds ratio (OR) 0.66; p=0.04) or no supplements (OR 0.34; p=0.007), and bilateral subtotal thyroidectomy (BST) compared to Hartley Dunhill (HD) procedure (OR 0.35; p=0.01). Meta-analyses did not demonstrate any measure to be significantly associated with a reduction in permanent hypocalcemia. CONCLUSION This review identified postoperative calcium and vitamin D supplementation and bilateral subtotal thyroidectomy (over HD) as being effective in prevention of transient hypocalcemia. However, the majority of RCTs were of low quality, primarily due to a lack of blinding. The wide variability in study design, definitions of hypocalcemia, and methods of assessment prevented meaningful summation of results for permanent hypocalcemia.
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Affiliation(s)
- Ramez Antakia
- 1 Department of Oncology, School of Medicine, University of Sheffield , Sheffield, United Kingdom
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Cannizzaro MA, Lo Bianco S, Borzì L, Cavallaro A, Buffone A. The use of FOCUS Harmonic scalpel compared to conventional haemostasis (knot and tie ligation) for thyroid surgery: a prospective randomized study. SPRINGERPLUS 2014; 3:639. [PMID: 25392807 PMCID: PMC4218928 DOI: 10.1186/2193-1801-3-639] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 10/20/2014] [Indexed: 11/10/2022]
Abstract
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.
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Affiliation(s)
- Matteo Angelo Cannizzaro
- Department of "Scienze Chirurgiche, Trapianti d'Organo e tecnologie Avanzate", University of Catania. Endocrine surgery Unit, "Policlinico-Vittorio Emanuele" Hospital, Catania, Italy
| | - Salvatore Lo Bianco
- Department of "Scienze Chirurgiche, Trapianti d'Organo e tecnologie Avanzate", University of Catania. Endocrine surgery Unit, "Policlinico-Vittorio Emanuele" Hospital, Catania, Italy
| | - Laura Borzì
- Department of "Scienze Chirurgiche, Trapianti d'Organo e tecnologie Avanzate", University of Catania. Endocrine surgery Unit, "Policlinico-Vittorio Emanuele" Hospital, Catania, Italy
| | - Andrea Cavallaro
- Department of "Scienze Chirurgiche, Trapianti d'Organo e tecnologie Avanzate", University of Catania. Endocrine surgery Unit, "Policlinico-Vittorio Emanuele" Hospital, Catania, Italy
| | - Antonino Buffone
- Department of "Scienze Chirurgiche, Trapianti d'Organo e tecnologie Avanzate", University of Catania. Endocrine surgery Unit, "Policlinico-Vittorio Emanuele" Hospital, Catania, Italy
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Total thyroidectomy with harmonic scalpel combined to gelatin-thrombin matrix hemostatic agent: Is it safe and effective? A single-center prospective study. Int J Surg 2014; 12 Suppl 1:S209-12. [DOI: 10.1016/j.ijsu.2014.05.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 05/03/2014] [Indexed: 12/20/2022]
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Blood loss and operative duration using monopolar electrosurgery versus ultrasound scissors for surgical preparation during thoracoscopic ventral spondylodesis: results of a randomized, blinded, controlled trial. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 23:1783-90. [PMID: 24760465 DOI: 10.1007/s00586-014-3303-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 11/24/2013] [Accepted: 04/04/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Monopolar electrosurgery is the gold standard for surgical preparation in thoracoscopic spine procedures. However, use of ultrasound scissors could decrease blood loss, accelerate the preparation time and improve patient safety, while minimizing operative costs. This trial compares both preparation techniques for ventral thoracoscopic spondylodesis. METHODS The study design is an open, prospective, randomized, and double-blinded two-armed clinical trial performed in two centres. Forty-one patients with vertebral body fractures from T10 to L2 were included. Primary endpoint: preparation time. Secondary endpoints: blood loss, organ injuries, duration of hospitalization. RESULTS Primary and secondary endpoints did not differ significantly between groups (p level 0.05). Increased blood loss (150 ml or more) was eliminated with ultrasound scissors (p = 0.0014). CONCLUSIONS Primary and secondary endpoints did not differ significantly between the two preparation techniques. The use of either ultrasound scissors or electric scalpel offers safe and effective preparation for thoracoscopic spine surgery.
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Iorgulescu R, Badanoiu D, Lupu A, Cucu C, Niculescu D, Iordache N. Lessons learned from the first 50 thyroidectomies with Harmonic Focus Curved Shears - technical note. J Med Life 2014; 7 Spec No. 4:54-61. [PMID: 27057249 PMCID: PMC4813618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Precise and safe hemostasis is necessary for successful thyroid surgery. In this respect, the advent of the ultrasonic surgical device Harmonic Focus Curved Shears (HFCS) from Ethicon Endo-Surgery constituted a major progress in the domain by its multiple capabilities of dissection, grasping, vessel sealing and transecting. The paper presents the initial experience of 50 cases with this device of a surgical team with special interest in endocrine surgery, mostly thyroid and parathyroid. The thyroid conditions for which surgery was indicated were: diffuse toxic goiter in 8 patients; multinodular toxic and nontoxic goiter in 30 patients; autonomous nodule in 2 patients; 2 patients with benign nodules at fine needle aspiration biopsy (FNAB); 4 patients with nodules positive for carcinoma at FNAB, among them 2 with unilateral cervical lymph nodes enlargement; 4 patients with highly suspect nodule on FNAB. The types of surgery performed were 4 hemithyroidectomies and 46 total thyroidectomies, 2 in association with unilateral functional neck dissections. We had 4 intraoperative hemorrhagic incidents, all in the first 15 cases and imputable to lack of expertise and improper usage of the device. We registered the following noticeable postoperative complications: 1 cervical hematoma from an arteriolar source in sternothyroid muscle demanding prompt reintervention; 8 hypocalcemias and 2 vocal cord paresis, none of which permanent. We remarked several advantages with HFCS: no necessity of changing instruments, fluentness of the intervention and more comfort for the operating team, reduced operating time, safe hemostasis. Some important tips and tricks with the usage of the instrument are presented.
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Affiliation(s)
- R Iorgulescu
- Emergency Clinical Hospital “Sf. Ioan” Bucharest
| | - D Badanoiu
- Emergency Clinical Hospital “Sf. Ioan” Bucharest
| | - A Lupu
- Emergency Clinical Hospital “Sf. Ioan” Bucharest
| | - C Cucu
- National Institute of Endocrinology “CI Parhon” Bucharest
| | - D Niculescu
- National Institute of Endocrinology “CI Parhon” Bucharest
| | - N Iordache
- Emergency Clinical Hospital “Sf. Ioan” Bucharest
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Duan YF, Xue W, Zhu F, Sun DL. FOCUS harmonic scalpel compared to conventional hemostasis in open total thyroidectomy - a prospective randomized study. J Otolaryngol Head Neck Surg 2013; 42:62. [PMID: 24359618 PMCID: PMC3892114 DOI: 10.1186/1916-0216-42-62] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 12/16/2013] [Indexed: 11/12/2022] Open
Abstract
Background Hemostasis in thyroid surgery is of utmost importance for a successful surgery and an uneventful postoperative course. Our aim was to evaluate the effectiveness of the FOCUS Harmonic Scalpel in patients undergoing open total thyroidectomy. Methods In this study, 778 patients were randomized into 2 groups based on the surgical technique used: group I comprised the conventional clamp-and-tie technique, group II comprised patients in whom the FOCUS Harmonic Scalpel was used exclusively. The groups were compared in regard to surgical time, complications, and hospital stay. Results Surgical time was significantly lower in group II compared with group I (79 ± 21.5 min vs.125 ± 30.4, respectively, P < 0.001). Twenty-seven patients (6.94%) in group I experienced symptomatic hypocalcemia requiring calcium and/or vitamin D therapy versus 14 patients (3.6%) in group II, with statistically significant difference (P < 0.05). Mean post-operative hospital stay was significantly lower in group II compared with group I (2.6 ± 0.9 vs. 2.9 ± 1.0; P < 0.001). Conclusions The FOCUS Harmonic Scalpel can shorten operative time and hospital stay, reduce incidence of symptomatic hypocalcemia but not transient hypoparathyroidism, and show no significance on recurrent nerve injury. FOCUS Harmonic Scalpel is supposed to be a more reliable and safe instrument that can take place of the clamp-and-tie technique in total thyroidectomy.
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Affiliation(s)
| | | | | | - Dong-lin Sun
- Department of General Surgery, The Third Affiliated Hospital of Soochow University, 185 Juqian Street, Changzhou, Jiangsu 213003, China.
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da Silva FB, Limoeiro ACDO, Del Bianco J, Teich V, Teich N, Teixeira JC, Vasconcelos AL, Sardenberg C. Impact of the use of vessel sealing or harmonic scalpel on intra-hospital outcomes and the cost of thyroidectomy procedures. EINSTEIN-SAO PAULO 2013; 10:354-9. [PMID: 23386017 DOI: 10.1590/s1679-45082012000300017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 07/02/2012] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To analyze the operative time, length of hospitalization and cost, as well as the bleeding and pain observed during the postoperative period, of thyroidectomy procedures using vessel sealing, harmonic scalpel or the conventional technique. METHODS Retrospective analysis of thyroidectomies performed between 2007 and 2010 using either the conventional technique or minimally invasive techniques involving vessel sealing or a harmonic scalpel. Gender, age, primary diagnosis and procedure type were analyzed. The outcomes analyzed included the length of the procedure, length of hospital stay, need for blood product transfusions, pain and cost of hospitalization. The findings were based on a significance level of 5%, and statistical analyses were performed using the R software. RESULTS The use of the vessel sealing increased the duration of the surgery by approximately 47 minutes compared to the conventional technique (p<0.001), and the use of the harmonic scalpel decreased the duration of the surgery by approximately 32 minutes compared to the conventional technique (p<0.001). No statistically significant difference was found between the groups regarding the use of blood products and pain score. Procedures involving vessel sealing or a harmonic scalpel cost more than those using the conventional technique. CONCLUSION The use of harmonic scalpel was favorable in terms of reducing the surgical time, but there was no reduction in hospitalization time. The cost of the procedure was higher than that of the conventional technique. The use of vessel sealing offered no advantages in terms of the outcomes assessed, and the cost of the procedure was greater than that of the conventional technique.
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Contin P, Gooßen K, Grummich K, Jensen K, Schmitz-Winnenthal H, Büchler MW, Diener MK. ENERgized vessel sealing systems versus CONventional hemostasis techniques in thyroid surgery--the ENERCON systematic review and network meta-analysis. Langenbecks Arch Surg 2013; 398:1039-56. [PMID: 24240627 DOI: 10.1007/s00423-013-1137-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 10/25/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE Energized vessel-sealing systems have been proposed to save operation time and reduce post-operative complications. The aim of the present systematic review was to compare operation time and postoperative morbidity for ultrasonic and electrothermal bipolar-activated devices with conventional hemostasis techniques and with each other in open thyroidectomy. METHODS A systematic literature search (MEDLINE, Cochrane Library, EMBASE and ISI Web of Science) was performed to identify randomised controlled trials (RCTs) comparing conventional hemostasis techniques, ultrasonic devices (Harmonic® scalpel) and/or electrothermal bipolar-activated vessel sealing systems (Ligasure®) during open thyroidectomy. For the primary endpoint (operation time), a network meta-analysis with Bayesian random effects model was performed. Pairwise meta-analyses with random effects were calculated for primary and secondary endpoints. RESULTS One hundred sixteen publications were evaluated for eligibility; 35 RCTs (4,061 patients) were included. There was considerable methodological and clinical heterogeneity of included trials. The Harmonic scalpel significantly reduced operation time compared with conventional techniques (22.26 min, 22.7 min in the inconsistency model). The use of Ligasure significantly reduced operation time in total thyroidectomy (13.84 min in the consistency model, 12.18 min in the inconsistency model). In direct comparison, operations with the Harmonic scalpel were faster than with Ligasure (8.42 min in the consistency model, 2.45 min in the inconsistency model). The rates of recurrent nerve palsy and postoperative hypocalcaemia did not significantly differ in the intervention groups. CONCLUSIONS This meta-analysis shows superiority of ultrasonic devices in terms of operation time compared with conventional hemostasis techniques in thyroid surgery, with no detriment to safety outcomes.
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Affiliation(s)
- Pietro Contin
- Department of General-, Visceral- and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
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Garas G, Okabayashi K, Ashrafian H, Shetty K, Palazzo F, Tolley N, Darzi A, Athanasiou T, Zacharakis E. Which hemostatic device in thyroid surgery? A network meta-analysis of surgical technologies. Thyroid 2013; 23:1138-50. [PMID: 23470035 DOI: 10.1089/thy.2012.0588] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Energy-based hemostatic devices are increasingly being used in thyroid surgery. However, there are several limitations with regard to the existing evidence and a paucity of guidelines on the subject. The goal of this review is to employ the novel evidence synthesis technique of a network meta-analysis to assess the comparative effectiveness of surgical technologies in thyroid surgery and contribute to enhanced governance in the field of thyroid surgery. METHODS Articles published between January 2000 and June 2012 were identified from Embase, Medline, Cochrane Library, and PubMed databases. Randomized controlled trials of any size comparing the use of ultrasonic coagulation (harmonic scalpel) or Ligasure either head-to-head or against the "clamp-and-tie" technique were included. Two reviewers independently critically appraised and extracted the data from each study. The number of patients who experienced postoperative events was extracted in dichotomous format or continuous outcomes. Odds ratios were calculated by a Bayesian network meta-analysis, and metaregression was used for pair-wise comparisons. Indirect and direct comparisons were performed and inconsistency was assessed. RESULTS Thirty-five randomized controlled trials with 2856 patients were included. Ultrasonic coagulation ranked first (followed by Ligasure and then clamp-and-tie) with the lowest risk of postoperative hypoparathyroidism (odds ratio 1.43 [95% confidence interval (CI) 0.77-2.67] and 0.70 [CI 0.43-1.13], ultrasonic coagulation vs. Ligasure and ultrasonic coagulation vs. clamp-and-tie, respectively), least blood loss (-0.25 [CI -0.84 to -0.35] and -1.22 [CI -1.85 to -0.59]), and drain output (0.28 [CI -0.35 to -0.91] and -0.36 [CI -0.70 to -0.03]). From a health technology viewpoint, ultrasonic coagulation was associated with the shortest operative time (-0.66 [CI -1.17 to -0.14] and -1.29 [CI -1.59 to -1.00]) and hospital stay (-0.28 [CI -0.78 to 0.22] and -0.56 [CI -1.28 to 0.15]). The only exception occurs with the clinically important complication of recurrent laryngeal nerve paralysis, where the reverse trend applies (1.36 [CI 0.25-7.46] and 1.74 [CI 0.94-3.26]). CONCLUSIONS The comparative effectiveness of ultrasonic coagulation in thyroid surgery outcomes seems superior to other techniques with the exception of recurrent laryngeal nerve injury. This network meta-analysis, one of a handful in a surgical field, offers preliminary and robust evidence to guide clinical decisions and policy makers to adopt safer thyroid operations.
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Affiliation(s)
- George Garas
- 1 Department of Otorhinolaryngology and Head & Neck Surgery, Imperial College London , London, United Kingdom
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The impact of the Harmonic FOCUS™ on complications in thyroid surgery: a prospective multicenter study. Updates Surg 2013; 65:295-9. [DOI: 10.1007/s13304-013-0223-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Accepted: 06/21/2013] [Indexed: 10/26/2022]
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