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Lee E, Tong JY, Pasick LJ, Benito DA, Joshi A, Thakkar PG, Goodman JF. Complications associated with energy-based devices during thyroidectomy from 2010-2020. World J Otorhinolaryngol Head Neck Surg 2023; 9:35-44. [PMID: 37006740 PMCID: PMC10050967 DOI: 10.1016/j.wjorl.2021.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 04/27/2021] [Indexed: 12/12/2022] Open
Abstract
Objective Harmonic Focus (Ethicon, Johnson and Johnson, Cincinnati, OH, USA), LigaSure Small Jaw (Medtronic, Covidien Products, Minneapolis, MN, USA), and Thunderbeat Open Fine Jaw (Olympus, Japan) are electrosurgical instruments used widely in head and neck surgery. The study aims to compare device malfunctions, adverse events to patients, operative injuries, and interventions related to Harmonic, LigaSure, and Thunderbeat use during thyroidectomy. Methods The US Food and Drug Administration's Manufacture and User Facility Device Experience (MAUDE) database was queried for adverse events associated with Harmonic, LigaSure, and Thunderbeat from January 2005 to August 2020. Data were extracted from reports pertaining to thyroidectomy. Results Of the 620 adverse events extracted, 394 (63.5%) involved Harmonic, 134 (21.6%) LigaSure, and 92 (14.8%) Thunderbeat. The reported device malfunctions most frequently associated with Harmonic was damage to the blade (110 (27.9%)), LigaSure was inappropriate function (47 (43.1%)), Thunderbeat was damage to the tissue or Teflon pad (27 (30.7%)), respectively. Burn injury and incomplete hemostasis were the most commonly reported adverse events. The operative injury reported most frequently when using Harmonic and LigaSure was burn injury. No operator injuries were reported with Thunderbeat use. Conclusion The most frequently reported device malfunctions were damage to the blade, inappropriate function, and damage to the tissue or Teflon pad. The most frequently reported adverse events to patients was a burn injury and incomplete hemostasis. Interventions aimed at improving physician education may help reduce adverse events attributed to improper use.
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Affiliation(s)
- Esther Lee
- Division of Otolaryngology‐Head and Neck SurgeryGeorge Washington University School of Medicine & Health SciencesWashingtonDCUSA
- Western University of Health SciencesPomonaCAUSA
| | - Jane Y. Tong
- Department of Otolaryngology‐Head and Neck SurgeryDrexel University College of MedicinePhiladelphiaPAUSA
| | - Luke J. Pasick
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of Miami Miller School of MedicineMiamiFLUSA
| | - Daniel A. Benito
- Division of Otolaryngology‐Head and Neck SurgeryGeorge Washington University School of Medicine & Health SciencesWashingtonDCUSA
| | - Arjun Joshi
- Division of Otolaryngology‐Head and Neck SurgeryGeorge Washington University School of Medicine & Health SciencesWashingtonDCUSA
| | - Punam G. Thakkar
- Division of Otolaryngology‐Head and Neck SurgeryGeorge Washington University School of Medicine & Health SciencesWashingtonDCUSA
| | - Joseph F. Goodman
- Division of Otolaryngology‐Head and Neck SurgeryGeorge Washington University School of Medicine & Health SciencesWashingtonDCUSA
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2
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Lorange M, De Arburn Parent R, Huneault L, Gatineau M, Auger J, Liptak JM. Use of a vessel-sealing device versus conventional hemostatic techniques in dogs undergoing thyroidectomy because of suspected thyroid carcinoma. J Am Vet Med Assoc 2020; 254:1186-1191. [PMID: 31039092 DOI: 10.2460/javma.254.10.1186] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare use of a vessel-sealing device (VSD) versus conventional hemostatic techniques in dogs undergoing thyroidectomy because of suspected thyroid carcinoma. DESIGN Retrospective cohort study. ANIMALS 42 client-owned dogs undergoing thyroidectomy because of suspected thyroid carcinoma. PROCEDURES Medical records of dogs treated at 4 referral centers from 2010 through 2016 were reviewed, and information was obtained on patient signalment, surgical technique, tumor-specific factors, and operative duration. Postoperative hospitalization time and complications were compared between dogs grouped on the basis of hemostatic technique. RESULTS Thyroidectomy was performed with a VSD in 23 dogs and with conventional hemostatic techniques (ie, ligatures, hemoclips, or electrocautery) in 19 dogs. Hemostatic technique (ie, use of a VSD vs conventional hemostatic techniques) was the only factor significantly associated with operative duration (median time, 28 vs 41 minutes). Postoperative hospitalization times and complication rates did not differ between groups. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that use of a VSD, rather than conventional hemostatic techniques, in dogs undergoing thyroidectomy because of suspected thyroid carcinoma resulted in shorter operative times without significantly affecting complication rates or postoperative hospitalization times.
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Butskiy O, Chang BA, Luu K, McKenzie RM, Anderson DW. A systematic approach to the recurrent laryngeal nerve dissection at the cricothyroid junction. J Otolaryngol Head Neck Surg 2018; 47:57. [PMID: 30223884 PMCID: PMC6142389 DOI: 10.1186/s40463-018-0306-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 09/03/2018] [Indexed: 11/10/2022] Open
Abstract
Background To describe and evaluate a four step systematic approach to dissecting the recurrent laryngeal nerve (RLN) starting at the cricothyroid junction during thyroid surgery (subsequently referred to as the retrograde medial approach). Methods All thyroidectomies completed by the senior author between August 2014 and January 2016 were retrospectively reviewed. Patients were excluded if concurrent lateral or central neck dissection was performed. A follow up period of 1 year was included. Results Surgical photographs and illustrations demonstrate the four steps in the retrograde medial approach to dissection of the RLN in thyroid surgery. Three hundred forty-two consecutive thyroid surgeries were performed in 17 months, including 213 hemithyroidectomies, 91 total thyroidectomies, and 38 completion thyroidectomies. The rate of temporary and permanent hypocalcemia was 13% (95% confidence interval [CI]: 8–20%) and 3% (95% CI: 1–8%) respectively. The rate of temporary and permanent vocal cord palsy was 9% (95% CI: 6–12%) and 0.3% (95%CI: 0.01–2%) respectively. The median surgical times for hemithyroidectomy, total thyroidectomy, and completion thyroidectomy were 39 min (Interquartile range [IQR]: 33–47 min), 48 min (IQR: 40–60 min), and 40 min (IQR: 35–51 min) respectively. 1% of cases required conversion to an alternative surgical approach. Conclusion In a tertiary endocrine head and neck practice, the routine use of the retrograde medial approach to RLN dissection is safe and results in a short operative time, and a low conversion rate to other RLN dissection approaches.
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Affiliation(s)
- Oleksandr Butskiy
- Division of Otolaryngology - Head & Neck Surgery, University of British Columbia, Vancouver, BC, Canada. .,Gordon & Leslie Diamond Health Care Centre, 4th. Fl. 4299B-2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
| | - Brent A Chang
- Division of Otolaryngology - Head & Neck Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Kimberly Luu
- Division of Otolaryngology - Head & Neck Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Robert M McKenzie
- Division of Otolaryngology - Head & Neck Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Donald W Anderson
- Division of Otolaryngology - Head & Neck Surgery, University of British Columbia, Vancouver, BC, Canada
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Park MW, Baek SK, Park EH, Jung KY. Long-term voice outcome after thyroidectomy using energy based devices. Auris Nasus Larynx 2018; 45:527-532. [DOI: 10.1016/j.anl.2017.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 07/31/2017] [Accepted: 08/09/2017] [Indexed: 12/12/2022]
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Vidal O, Saavedra-Perez D, Valentini M, Astudillo E, Fernández-Cruz L, García-Valdecasas JC. Surgical outcomes of total thyroidectomy using the LigaSure™ Small Jaw versus LigaSure Precise™: A retrospective study of 2000 consecutive patients. Int J Surg 2016; 37:8-12. [PMID: 27565244 DOI: 10.1016/j.ijsu.2016.08.241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 08/15/2016] [Accepted: 08/18/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND We compared surgical outcomes of LigaSure™ Small Jaw, which is a multifunctional thermal device that incorporates a tissue divider versus LigaSure Precise™ in thyroid surgery. METHODS A retrospective, single-center study was carried out in an acute-care teaching hospital in Barcelona, Spain. Between January 2008 and June 2015, consecutive patients scheduled for total thyroidectomy were included in the study. Surgical outcomes were operative time, length of skin incision, use of a suction drain, intraoperative bleeding, postoperative complications and length of hospital stay. RESULTS A total of 2000 patients were included (LigaSure™ Small Jaw, n = 1000; LigaSure Precise™, n = 1000). Demographics and indication for surgery were similar in both groups. A significant and independent shorter operative time (median 40 vs. 65 min, P = 0.002), smaller length of the skin incision (mean [SD] 4 [2] vs. 7 [3] cm, P = 0.031), lower percentages of patients with suction drain (15% vs. 66%, P = 0.012) and intraoperative bleeding (4% vs. 9%, P = 0.045) and reduced length of stay (median 1 vs. 3 days, P = 0.039) were found in the LigaSure™ Small Jaw than in the LigaSure Precise™. Postoperative complications including haematoma, hypoparathyroidism and recurrent laryngeal nerve injury were similar. CONCLUSIONS The LigaSure™ Small Jaw in thyroid surgery results in significant less blood loss and operative time as well as shorter hospital stay compared to LigaSure Precise™. These findings could have direct application in daily practice.
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Affiliation(s)
- Oscar Vidal
- Department of Endocrine Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain.
| | - David Saavedra-Perez
- Department of Endocrine Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Mauro Valentini
- Department of Endocrine Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Emiliano Astudillo
- Department of Endocrine Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Laureano Fernández-Cruz
- Department of Endocrine Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Juan C García-Valdecasas
- Department of Endocrine Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
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Cheng H, Soleas IM, Ferko NC, Cameron CG, Clymer JW, Amaral JF. Hospital costs associated with thyroidectomy performed with a Harmonic device compared to conventional techniques: a systematic review and meta-analysis. J Med Econ 2016; 19:750-8. [PMID: 26999563 DOI: 10.3111/13696998.2016.1168826] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Harmonic devices have become a world-wide standard for dissection and hemostasis in thyroidectomy. Numerous systematic reviews have reported superior operating times, blood loss, post-operative pain, length of stay, and overall safety outcomes. What has not been extensively evaluated in a robust manner is their economic impact. The purpose of this study is to evaluate the hospital costs associated with open thyroidectomy using Harmonic devices compared with conventional techniques for hemostasis. METHODS A systematic review of Medline, Scopus, and CENTRAL was performed from January 1, 2000 to May 23, 2014 without language restrictions for randomized clinical trials comparing Harmonic surgical devices to conventional methods in thyroidectomy. The main outcome measure was total reported costs. Costs were pooled using the ratio of means and a random effects model. Sensitivity analyses assessed whether differences in patient and trial characteristics, healthcare setting, or choice of statistical model affected outcomes. RESULTS Seven studies met the inclusion criteria. A total of 476 participants had procedures performed with Harmonic devices and 478 with conventional monopolar electrosurgery and clamp, cut and tie techniques. Compared with conventional techniques, Harmonic devices reduced total reported costs by 10% (p = 0.007), resulting in a $229 US dollars (USD) absolute reduction from mean baseline costs. Results remained relatively robust to additional sensitivity analyses. CONCLUSIONS This systematic review and meta-analysis demonstrates that the Harmonic family of surgical devices is associated with a reduction in total reported costs in thyroidectomy compared with conventional techniques. A large portion of the overall savings derives from a reduction in operative costs.
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Affiliation(s)
- Gaosong Wu
- Department of Thyroid and Breast Surgery, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Deguang Kong
- Department of Thyroid and Breast Surgery, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
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Ambe PC, Wassenberg DR. Is sutureless thyroid surgery safe in the hands of surgical trainees. A single centre retrospective study. BMC Res Notes 2016; 9:118. [PMID: 26905580 PMCID: PMC4763438 DOI: 10.1186/s13104-016-1940-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 02/17/2016] [Indexed: 12/14/2022] Open
Abstract
Background The safety and efficacy of sutureless thyroid surgery have been confirmed in many series. Equally, surgical expertise has been shown to influence postoperative outcome. This study aimed at investigating the safety of sutureless thyroid surgery in the hands of surgical trainees and to find out if this technique could be safely integrated into endocrine surgical training programs. Methods A single center retrospective comparison of the outcome of surgeries performed by experienced surgical attendings and trainees was performed. The LigaSure Precise was used in all cases. Results Two hundred and eight patients were included. The trainee group comprised of 61 cases managed by surgical trainees. Surgery was performed by surgical attendings in 147 cases (consultant group). The incidences of transient and permanent hypocalcaemia were 20.7 and 0.9 % respectively, the corresponding values for recurrent nerve injury were 6.3 and 0.9 %. Postoperative bleeding occurred in 3.4 %. There was no difference amongst both groups with regard to postoperative outcome (p > 0.05). Conclusions While sutureless thyroid surgery was safely performed by surgical trainees without relevant increase in perioperative complications in our department, further larger scale studies would be needed to confirm this would be the case more widely.
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Affiliation(s)
- Peter C Ambe
- Department of General, Visceral and Thoracic Surgery, St. Remigius Hospital Opladen, 51379, Leverkusen, Germany. .,Department of Surgery II, Helios Klinikum Wuppertal, Witten-Herdecke University, Heusnerstr. 40, 42283, Wuppertal, Germany.
| | - Dirk R Wassenberg
- Department of General, Visceral and Thoracic Surgery, St. Remigius Hospital Opladen, 51379, Leverkusen, Germany.
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Kirschbaum A, Rüdell F, Pehl A, Bartsch DK. More compression improves sealing effect on larger pulmonary arteries. J Surg Res 2016; 201:202-7. [PMID: 26850203 DOI: 10.1016/j.jss.2015.09.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 08/12/2015] [Accepted: 09/24/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Small arteries and veins up to 7 mm can be sealed safe and divided with a bipolar sealing instrument. The results for the safe sealing of larger vessels were unsatisfactory in the past. Using an ex vivo pulmonary artery model, we aimed to investigate, if a higher compression force and duration will improve the bursting pressures in case of vessels >7 mm. MATERIAL AND METHODS Heart-lung preparations (from 90 kg pigs) were removed en bloc at a slaughterhouse. The whole pulmonary artery was exposed from the pulmonary valve up to the periphery of the left lung. In the laboratory, a digital pressure sensor was implanted in the central end of the blood vessel to measure the bursting pressure (in mbar). The vessels examined were divided into three groups by diameter: 1-6 mm, 7-12 mm and >12 mm. After bipolar sealing, bursting pressures were determined by pneumatic testing. Seals were made using three equal MARSEAL instruments (Gebrüder Martin GmbH & CoKG, Tuttlingen, Germany) with a SealSafe G3 electric current and different jaw compression forces of each 35 N, 45 N, and 55 N. Bursting pressures were also measured for different compression durations (0 s, 5 s, 10 s, and 20 s) with 35 N compression. Mean bursting pressures were calculated for each group (n = 15). Groups were compared using a nonparametric test (Mann-Whitney U test). The significance level was P < 0.05. RESULTS Mean bursting pressures in the 1-6 mm blood vessels were 290.5 ± 77.1 mbar (35 N), 323.0 ± 76.0 mbar (45 N) and 301.6 ± 69.9 mbar (55 N). The groups did not differ significantly. Mean bursting pressures in the 7-12 mm vessels were 108.1 ± 19.1 mbar (35 N), 154.3 ± 28.5 mbar (45 N), and 212.4 ± 45.3 mbar (55 N). In blood vessels >12 mm in diameter, we found mean bursting pressures of 77.7 ± 11.7 mbar (35 N), 117.6 ± 27.1 mbar (45 N), and 166.3 ± 56.6 mbar (55 N). The results for the groups with 55 N compression were significantly higher than for the other groups. A compression duration of 5 s led to significantly higher mean bursting pressures than a duration of 0 s but a duration of >5 s did not bring a further significant increase in mean bursting pressure. Histologic staining of the seal zone and microscopic examination did not reveal any differences relating to compression force. CONCLUSIONS With a higher compression force, we reached satisfactory bursting pressures in case of pulmonary arteries >7 mm. An additional 5 s of compression before starting coagulation brings a further significant increase in bursting pressure. However, there is no advantage in a longer compression.
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Affiliation(s)
- Andreas Kirschbaum
- Department of Visceral, Thoracic and Vascular Surgery, Giessen and Marburg University Hospital (UKGM), Marburg, Germany.
| | - Franziska Rüdell
- Department of Visceral, Thoracic and Vascular Surgery, Giessen and Marburg University Hospital (UKGM), Marburg, Germany
| | - Anika Pehl
- Institute of Pathology, Giessen and Marburg University Hospital (UKGM), Marburg, Germany
| | - Detlef K Bartsch
- Department of Visceral, Thoracic and Vascular Surgery, Giessen and Marburg University Hospital (UKGM), Marburg, Germany
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Abstract
Since its invention nearly 20 years ago, the Covidien LigaSure device along with its ForceTriad generator has dominated the Electrothermal Bipolar Vessel Sealing market. The LigaSure was used for surgical procedures, both open and laparoscopic. The purpose of this review is to provide evidence of the safety and utility of the LigaSure device compared to more traditional means of hemostasis and its ultrasonic competitor, particularly in laparoscopic applications. We will provide evidence related to electrothermal bipolar vessel sealing in general and look specifically at Covidien's newest product, the LigaSure Maryland Jaw Device.
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Affiliation(s)
- Nisar Zaidi
- Endocrine Surgical Unit, Royal North Shore Hospital, University of Sydney, St. Leonards, New South Wales 2065, Australia
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