US Evaluation of Topical Hemostatic Agents in Post-Thyroidectomy

SIMPLE SUMMARY: To reduce bleeding-related morbidity in th yroid surgery, new techniques and devices for controlling bleeding have been introduced in addition to traditional hemostasis. Innovative technological tools based on mechanical hemostasis systems, conventional mono- and bipolar electrosurgery systems, and radiofrequency and ultrasound systems can be variably associated with topical hemostatic agents and surgical sealants to improve hemostasis and avoid intra- and post-operative bleeding. The aim of the study was to describe the ultrasound (US) appearance of topical hemostatics in patients who were undergoing thyroidectomy. In particular, the study focused on the ultrasound appearance of a hemostatic swab, which in cases of incomplete resorption, can simulate disease recurrence (in oncological patients) or native gland residue. The study evaluated the possible advantages and disadvantages of the application of these agents to thyroid surgery, in particular those based on oxidized and regenerated cellulose and fibrin glue. The preliminary data reported in this study show that the effectiveness of hemostatic fibrin glue in preventing bleeding is comparable to oxidized regenerated cellulose swab; however, unlike the swab, the fibrin glue does not show any detectable residues at the US examination. ABSTRACT: Background: the aim of this study was to describe the ultrasound appearance of topical hemostatics after thyroidectomy. Methods: we enrolled 84 patients who were undergoing thyroid surgery and were treated with two types of topical hemostats, 49 with an absorbable hemostat of oxidized regenerated cellulose (Oxitamp(®)) and 35 with a fibrin glue-based hemostat (Tisseel(®)). All patients were examined using B-mode ultrasound. Results: In 39 patients of the first group (approximately 80%), a hemostatic residue was detected and in some cases confused with a native gland residue, or with cancer recurrence in oncological patients. No residue was detected in patients in the second group. The main ultrasound characteristics of the tampon were analyzed and arranged according to predefined patterns, and suggestions to recognize it and avoid wrong diagnoses were provided. A part of the group of patients with tampon residue was re-evaluated after 6–12 months, ensuring that the swab remained for months after the maximum resorption time declared by the manufacturer. Conclusions: with equal hemostatic effectiveness, the fibrin glue pad is more favorable in the ultrasound follow-up because it creates reduced surgical outcomes. It is also important to know and recognize the ultrasound characteristics of oxidized cellulose-based hemostats in order to reduce the number of diagnostic errors and inappropriate diagnostic investigations.