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Pino A, Frattini F, Sun H, Zhang D, Wu CW, Kim HY, Dionigi G. Use of Vivostat® Autologous Fibrin Sealant in Thyroid Surgery. Surg Technol Int 2021; 38:57-61. [PMID: 34043230 DOI: 10.52198/21.sti.38.so1441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Post-thyroidectomy hemorrhage is a rare but potentially life-threatening and unpredictable complication of thyroid surgery. Therefore, intraoperative bleeding control and hemostasis are crucial. However, the most efficient, cost-effective, and standardized way to achieve this is not clear. This study aimed to evaluate the outcome of total thyroidectomy (TT) and partial thyroidectomy (PT) performed using the Vivostat® hemostatic system (Vivostat A/S, Lillerød, Denmark). METHODS Patients underwent TT and PT for benign and malignant diseases (multinodular goiter, Graves' disease, differentiated thyroid carcinoma). The primary endpoint was 1st-day postoperative drain output and bleeding that required reintervention. Secondary endpoints included surgery duration and postsurgical complications (vocal fold palsy, hypocalcemia, seroma, wound infection). RESULTS Between October 2020 and December 2020, 56 patients were enrolled; 69.6% female; mean age 49.5 years. The mean 24-h drain output was 40 ml. No redo surgery was needed. Seroma was present in 5.3% of cases; no permanent vocal palsy or hypocalcemia was observed. CONCLUSION This study shows that the Vivostat® system is both safe and effective for hemostasis during thyroid surgery.
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Affiliation(s)
- Antonella Pino
- Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital G. Martino, University of Messina, Messina, Italy
| | - Francesco Frattini
- Division of General Surgery, Ospedale di Circolo e Fondazione Macchi di Varese - ASST dei Sette Laghi, Italy
| | - Hui Sun
- Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Changchun, China
| | - Daqi Zhang
- Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Changchun, China
| | - Che Wei Wu
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hoon Yub Kim
- Department of Surgery, Division of Breast and Endocrine Surgery, Minimally Invasive Surgery and Robotic Surgery Center, KUMC Thyroid Center Korea University, Anam Hospital, Seoul, Republic of Korea
| | - Gianlorenzo Dionigi
- Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital G. Martino, University of Messina, Messina, Italy
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Khadra H, Bakeer M, Hauch A, Hu T, Kandil E. Hemostatic agent use in thyroid surgery: a meta-analysis. Gland Surg 2018; 7:S34-S41. [PMID: 30175062 DOI: 10.21037/gs.2018.03.02] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The use of hemostatic agents in thyroid surgery has been widely reported in the literature. The aim of this study is to assess the safety and efficacy of hemostatic agents in comparison to conventional techniques for hemostasis by meta-analysis of the current literature. Methods Articles were identified from PubMed and EMBASE using the following keyword searches: "hemostatic agent and thyroid surgery" and "hemostatic agent and thyroidectomy". Outcomes included total operative time, estimated blood loss, length of hospital stay, and intraoperative and postoperative complications. Data were extracted following review of appropriate studies by two independent authors and outcome differences were calculated using analysis of variance and the Bonferroni method. Results Thirty-four publications were identified and 10 studies met our inclusion criteria, totaling 941 patients, 519 (55.1%) of which received a hemostatic agent during thyroid surgery. Of these patients who had hemostatic agents, 369 (71%) received a hemostatic gel and 150 (29%) received an oxidized cellulose patch. Outcome measures in each of these groups were compared with the patients receiving only conventional methods of hemostasis. The risk of hematoma formation in the hemostatic gel group was comparable to conventional hemostatic methods (95% CI: 0.33, 2.59). This was also true when comparing conventional hemostasis to the patch (95% CI: 0.64, 15.24). No difference in the risk for seroma formation was found between the conventional and hemostatic gel groups (95% CI: 0.26, 3.95). Drain output was significantly less in the gel group 40.75±35.6 mL compared to 66.26±31.2 mL in the conventional group (95% CI: -23.422, -7.460). Patients who received hemostatic agents had shorter hospital stays when compared to the conventional group (95% CI: -1.057, -0.203). Conclusions Our meta-analysis suggests that the use of a hemostatic agent in thyroid surgery yields minimal advantages for the management of perioperative bleeding risk.
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Affiliation(s)
- Helmi Khadra
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Mohamed Bakeer
- Department of Surgery, Louisiana State University School of Medicine, New Orleans, LA, USA
| | - Adam Hauch
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Tian Hu
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Emad Kandil
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
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Morelli L, Guadagni S, Troia E, Di Franco G, Palmeri M, Caprili G, D'Isidoro C, Moglia A, Pisano R, Pietrabissa A, Cuschieri A, Mosca F. Use of a novel multi-purpose sponge for laparoscopic surgery: Does it have special relevance to robotically-assisted laparoscopic surgery? J Minim Access Surg 2016; 12:315-20. [PMID: 27251845 PMCID: PMC5022510 DOI: 10.4103/0972-9941.182654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND: The STAR System (Ekymed SpA) is a novel multipurpose sponge developed for conventional manual laparoscopic surgery. MATERIALS AND METHODS: Between December 2012 and December 2014, we successfully used the sponge in ten robot-assisted and ten direct manual laparoscopic operations to achieve haemostasis, for blunt dissections, for atraumatic lifting of solid organs, to check for bile leaks, for cleaning the surgical field thus avoiding frequent use of suction or the application of haemostatic agents. The reason of the insertion (RI), the main use (MU) and any further use (FU), once inserted, were registered for each operation and compared between the two groups. RESULTS: The principal RI was haemostasis for minor bleeding, without differences between the two groups (P = not significant). Regard to MU, in the robotic group cleaning the surgical field was utilised more than laparoscopic group (100% vs. 60%; P = 0.03). About FU, atraumatic solid organs lifting was more frequent during robotically assisted surgery than with laparoscopy (50% vs. 0%; P = 0.01). A statistically more frequent use of the sponge was registered during standard laparoscopy for the blunt dissection (30% vs. 80%; P = 0.03). CONCLUSIONS: The STAR System was beneficial in both approaches, but it imparts added benefit during robotically-assisted laparoscopic surgery organs because of the lack of tactile feedback and because the operating surgeon is remote from the patient, and has to rely on the assisting surgeon in the sterile field for dealing with bleeding episodes, cleansing/mopping the operative field when necessary, who may not be experienced or completely proficient.
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Affiliation(s)
- Luca Morelli
- EndoCAS, Center for Computer Assisted Surgery, University of Pisa; General Surgery Unit, Department of Oncology Transplantation and New Technologies, University of Pisa, Pisa, Italy
| | - Simone Guadagni
- General Surgery Unit, Department of Oncology Transplantation and New Technologies, University of Pisa, Pisa, Italy
| | - Elena Troia
- BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Italy
| | - Gregorio Di Franco
- General Surgery Unit, Department of Oncology Transplantation and New Technologies, University of Pisa, Pisa, Italy
| | - Matteo Palmeri
- General Surgery Unit, Department of Oncology Transplantation and New Technologies, University of Pisa, Pisa, Italy
| | - Giovanni Caprili
- General Surgery Unit, Department of Oncology Transplantation and New Technologies, University of Pisa, Pisa, Italy
| | - Cristiano D'Isidoro
- General Surgery Unit, Department of Oncology Transplantation and New Technologies, University of Pisa, Pisa, Italy
| | - Andrea Moglia
- EndoCAS, Center for Computer Assisted Surgery, University of Pisa, Pisa, Italy
| | - Roberta Pisano
- General Surgery Unit, Department of Oncology Transplantation and New Technologies, University of Pisa, Pisa, Italy
| | | | | | - Franco Mosca
- EndoCAS, Center for Computer Assisted Surgery, University of Pisa, Pisa, Italy
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Robotic surgery and hemostatic agents in partial nephrectomy: a high rate of success without vascular clamping. J Robot Surg 2015; 9:215-22. [PMID: 26531202 DOI: 10.1007/s11701-015-0519-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 06/16/2015] [Indexed: 02/08/2023]
Abstract
Robot-assisted partial nephrectomy has been proposed as a technique to overcome technical challenges of laparoscopic partial nephrectomy. We prospectively collected and analyzed data from 31 patients who underwent robotic partial nephrectomy with systematic use of hemostatic agents, between February 2009 and October 2014. Thirty-three renal tumors were treated in 31 patients. There were no conversions to open surgery, intraoperative complications, or blood transfusions. The mean size of the resected tumors was 27 mm (median 20 mm, range 5-40 mm). Twenty-seven of 33 lesions (82%) did not require vascular clamping and therefore were treated in the absence of ischemia. All margins were negative. The high partial nephrectomy success rate without vascular clamping suggests that robotic nephron-sparing surgery with systematic use of hemostatic agents may be a safe, effective method to completely avoid ischemia in the treatment of selected renal masses.
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Ahnen TV, Ahnen MV, Wirth U, Barisic A, Schardey HM, Schopf S. Comparison of an Intraoperative Application of a Haemostatic Agent (PerClot<sup>®</sup>) with Conventional Haemostatic Procedure after Thyroid Resection. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/ss.2015.66037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Ersoy YE, Aysan E, Meric A, Kadioglu H, Cengiz MB, Bozkurt S, Memmi N, Cipe G, Muslumanoglu M. Does adrenaline spraying over thyroidectomy area reduce bleeding? Int J Clin Exp Med 2014; 7:274-279. [PMID: 24482716 PMCID: PMC3902268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 12/12/2013] [Indexed: 06/03/2023]
Abstract
BACKGROUND Means to prevent and control intra- or postoperative bleeding remain a topic of utmost importance in thyroidectomy. In this randomised clinical trial, we used adrenaline spraying to see if it helps bleeding control and reduces drainage and hematoma formation after thyroidectomy. METHODS After total thyroidectomy, 1 mg/ml adrenaline solution in 10 ml saline was sprayed all over the operation area by a syringe in 40 patients of "Adrenaline (+) Group". In the other 40 patients in "Adrenaline (-) Group", only standart total thyroidectomy was performed. Drainage amounts of 24 hours were recorded. RESULTS Among 80 patients, 66 (82.5%) were female and 14 (17.5%) were male. The daily drainage amounts of the Adrenaline (+) Group were found statistically significantly lower than the Adrenaline (-) Group (p<0.05). In both of the groups, thyroid volumes were significantly correlated with the drainage amounts. "p" values were 0.008 and <0.001 in Adrenaline (+) and Adrenaline (-) Groups, respectively. CONCLUSIONS Preliminary experience using adrenaline has been encouraging and it is useful as an adjunct to thyroid surgery in order to prevent hemorrhagia and give up drain placement. But prospective randomized trials using adequate patient numbers are still needed to validate efficacy and safety.
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Affiliation(s)
- Yeliz E Ersoy
- Department of General Surgery, Faculty of Medicine, Bezmialem Vakif University34306 Vatan Caddesi, Fatih, Istanbul, Turkey
| | - Erhan Aysan
- Department of General Surgery, Faculty of Medicine, Bezmialem Vakif University34306 Vatan Caddesi, Fatih, Istanbul, Turkey
| | - Aysenur Meric
- Department of Head and Neck Surgery, Faculty of Medicine, Bezmialem Vakif University34306 Vatan Caddesi, Fatih, Istanbul, Turkey
| | - Huseyin Kadioglu
- Department of General Surgery, Faculty of Medicine, Bezmialem Vakif University34306 Vatan Caddesi, Fatih, Istanbul, Turkey
| | - Merve B Cengiz
- Department of General Surgery, Faculty of Medicine, Bezmialem Vakif University34306 Vatan Caddesi, Fatih, Istanbul, Turkey
| | - Suleyman Bozkurt
- Department of General Surgery, Faculty of Medicine, Bezmialem Vakif University34306 Vatan Caddesi, Fatih, Istanbul, Turkey
| | - Naim Memmi
- Department of General Surgery, Faculty of Medicine, Bezmialem Vakif University34306 Vatan Caddesi, Fatih, Istanbul, Turkey
| | - Gokhan Cipe
- Department of General Surgery, Faculty of Medicine, Bezmialem Vakif University34306 Vatan Caddesi, Fatih, Istanbul, Turkey
| | - Mahmut Muslumanoglu
- Department of General Surgery, Faculty of Medicine, Bezmialem Vakif University34306 Vatan Caddesi, Fatih, Istanbul, Turkey
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Dionigi G, Bacuzzi A, Rovera F, Boni L, Piantanida E, Tanda ML, Castano P, Annoni M, Bartalena L, Dionigi R. Shortening hospital stay for thyroid surgery. Expert Rev Med Devices 2014; 5:85-96. [DOI: 10.1586/17434440.5.1.85] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Tublin ME, Alexander JM, Ogilvie JB. Appearance of absorbable gelatin compressed sponge on early post-thyroidectomy neck sonography: a mimic of locally recurrent or residual thyroid carcinoma. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2010; 29:117-120. [PMID: 20040783 DOI: 10.7863/jum.2010.29.1.117] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Absorbable gelatin compressed sponge (Gelfoam; Pfizer Inc, New York, NY), a biodegradable agent prepared from purified porcine skin gelatin, is frequently used for intraoperative hemostasis. Its appearance on sonography may mimic tumor or residual thyroid when placed in the resection bed after thyroidectomy. The purpose of this study was to describe the appearance of Gelfoam on early post-thyroidectomy sonography so that an erroneous diagnosis of locally recurrent or residual tumor can be avoided. METHODS We reviewed the early postoperative sonographic examinations of 6 patients after thyroidectomy in which Gelfoam was used for hemostasis. Screening cervical sonography was performed to identify possible lateral compartment adenopathy before completion of thyroidectomy or ablation. Sonographic examinations were performed up to 50 days after resection. Surgical reports confirmed the use of Gelfoam in each patient. RESULTS In all cases, uniform elongated echogenicity was shown within the lobectomy bed. In 1 patient, sonographically guided fine-needle aspiration of lobectomy bed echogenicity yielded scant red blood cells, multinucleated giant cells, and macrophages. Follow-up sonography performed in 1 patient 14 months after thyroidectomy confirmed complete Gelfoam absorption. CONCLUSIONS Gelfoam may mimic residual or recurrent thyroid carcinoma on early surveillance sonography performed after thyroidectomy. Recognition of its characteristic appearance should prompt a search for an appropriate surgical history and, when placed in the appropriate clinical context, should prevent an errant diagnosis of tumor.
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Affiliation(s)
- Mitchell E Tublin
- Department of Radiology, University of Pittsburgh School of Medicine, 200 Lothrop St, Pittsburgh, Pennsylvania15213, USA.
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