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Comparison of Surgical Complications Rates Between LigaSure Small Jaw and Clamp-and-Tie Hemostatic Technique in 1,000 Neuro-Monitored Thyroidectomies

Over the past decade, the use of neuromonitoring in thyroid surgery has become well established and is increasing accepted across the world. In addition, new developments in energy devices have significantly improved efficacy in achieving hemostasis in thyroid surgery. Few studies focused on the com...

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Autores principales: Liu, Cheng-Hsin, Wang, Chih-Chun, Wu, Che-Wei, Lin, Yi-Chu, Lu, I-Cheng, Chang, Pi-Ying, Lien, Ching-Feng, Wang, Chien-Chung, Hwang, Tzer-Zen, Huang, Tzu-Yen, Chiang, Feng-Yu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8058413/
https://www.ncbi.nlm.nih.gov/pubmed/33897619
http://dx.doi.org/10.3389/fendo.2021.638608
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author Liu, Cheng-Hsin
Wang, Chih-Chun
Wu, Che-Wei
Lin, Yi-Chu
Lu, I-Cheng
Chang, Pi-Ying
Lien, Ching-Feng
Wang, Chien-Chung
Hwang, Tzer-Zen
Huang, Tzu-Yen
Chiang, Feng-Yu
author_facet Liu, Cheng-Hsin
Wang, Chih-Chun
Wu, Che-Wei
Lin, Yi-Chu
Lu, I-Cheng
Chang, Pi-Ying
Lien, Ching-Feng
Wang, Chien-Chung
Hwang, Tzer-Zen
Huang, Tzu-Yen
Chiang, Feng-Yu
author_sort Liu, Cheng-Hsin
collection PubMed
description Over the past decade, the use of neuromonitoring in thyroid surgery has become well established and is increasing accepted across the world. In addition, new developments in energy devices have significantly improved efficacy in achieving hemostasis in thyroid surgery. Few studies focused on the complication rates in energy device-assisted sutureless neuro-monitored thyroidectomy. This study investigates a novel LigaSure Small Jaw (LSJ) technique for sutureless thyroidectomy and compares the surgical complication rates between LSJ and conventional clamp-and-tie technique in one thousand consecutive neuro-monitored thyroidectomy patients. Five hundred patients received sutureless thyroidectomy performed with LSJ (Group L), and 500 patients received surgery performed with conventional clamp-and-tie technique (Group C). Complication rates of postoperative hematoma, hypocalcemia and recurrent laryngeal nerve (RLN) palsy were compared between groups. The overall complication rates of hematoma, hypocalcemia (temporary/ permanent), and RLN (temporary/ permanent) palsy were 0.9%, 24.9% (24.6%/0.3%), and 1.7% (1.5%/0.2%), respectively. Group L and Group C significantly differed in postoperative hematoma rate (0.0% vs. 1.8%, respectively; p = 0.0026) and in postoperative hypocalcemia rate (20.1% vs. 30.0%, respectively; p = 0.0032). The incidence of RLN palsy did not significantly differ between Group L and Group C (1.38% vs. 2.08%; p = 0.2652). The overall surgical complication rates are low in neuro-monitored thyroidectomy. The LSJ is feasible for performing completely sutureless thyroidectomy and obtains superior outcomes of postoperative hematoma and hypocalcemia in comparison with clamp-and-tie hemostatic technique. The novel LSJ technique using double or overlapped sealing is useful for sutureless thyroidectomy. However, surgeons must carefully observe the tissue contraction that may reduce the LSJ-RLN distance and increase the risk of thermal injury during the LSJ activation.
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spelling pubmed-80584132021-04-22 Comparison of Surgical Complications Rates Between LigaSure Small Jaw and Clamp-and-Tie Hemostatic Technique in 1,000 Neuro-Monitored Thyroidectomies Liu, Cheng-Hsin Wang, Chih-Chun Wu, Che-Wei Lin, Yi-Chu Lu, I-Cheng Chang, Pi-Ying Lien, Ching-Feng Wang, Chien-Chung Hwang, Tzer-Zen Huang, Tzu-Yen Chiang, Feng-Yu Front Endocrinol (Lausanne) Endocrinology Over the past decade, the use of neuromonitoring in thyroid surgery has become well established and is increasing accepted across the world. In addition, new developments in energy devices have significantly improved efficacy in achieving hemostasis in thyroid surgery. Few studies focused on the complication rates in energy device-assisted sutureless neuro-monitored thyroidectomy. This study investigates a novel LigaSure Small Jaw (LSJ) technique for sutureless thyroidectomy and compares the surgical complication rates between LSJ and conventional clamp-and-tie technique in one thousand consecutive neuro-monitored thyroidectomy patients. Five hundred patients received sutureless thyroidectomy performed with LSJ (Group L), and 500 patients received surgery performed with conventional clamp-and-tie technique (Group C). Complication rates of postoperative hematoma, hypocalcemia and recurrent laryngeal nerve (RLN) palsy were compared between groups. The overall complication rates of hematoma, hypocalcemia (temporary/ permanent), and RLN (temporary/ permanent) palsy were 0.9%, 24.9% (24.6%/0.3%), and 1.7% (1.5%/0.2%), respectively. Group L and Group C significantly differed in postoperative hematoma rate (0.0% vs. 1.8%, respectively; p = 0.0026) and in postoperative hypocalcemia rate (20.1% vs. 30.0%, respectively; p = 0.0032). The incidence of RLN palsy did not significantly differ between Group L and Group C (1.38% vs. 2.08%; p = 0.2652). The overall surgical complication rates are low in neuro-monitored thyroidectomy. The LSJ is feasible for performing completely sutureless thyroidectomy and obtains superior outcomes of postoperative hematoma and hypocalcemia in comparison with clamp-and-tie hemostatic technique. The novel LSJ technique using double or overlapped sealing is useful for sutureless thyroidectomy. However, surgeons must carefully observe the tissue contraction that may reduce the LSJ-RLN distance and increase the risk of thermal injury during the LSJ activation. Frontiers Media S.A. 2021-04-07 /pmc/articles/PMC8058413/ /pubmed/33897619 http://dx.doi.org/10.3389/fendo.2021.638608 Text en Copyright © 2021 Liu, Wang, Wu, Lin, Lu, Chang, Lien, Wang, Hwang, Huang and Chiang https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Endocrinology
Liu, Cheng-Hsin
Wang, Chih-Chun
Wu, Che-Wei
Lin, Yi-Chu
Lu, I-Cheng
Chang, Pi-Ying
Lien, Ching-Feng
Wang, Chien-Chung
Hwang, Tzer-Zen
Huang, Tzu-Yen
Chiang, Feng-Yu
Comparison of Surgical Complications Rates Between LigaSure Small Jaw and Clamp-and-Tie Hemostatic Technique in 1,000 Neuro-Monitored Thyroidectomies
title Comparison of Surgical Complications Rates Between LigaSure Small Jaw and Clamp-and-Tie Hemostatic Technique in 1,000 Neuro-Monitored Thyroidectomies
title_full Comparison of Surgical Complications Rates Between LigaSure Small Jaw and Clamp-and-Tie Hemostatic Technique in 1,000 Neuro-Monitored Thyroidectomies
title_fullStr Comparison of Surgical Complications Rates Between LigaSure Small Jaw and Clamp-and-Tie Hemostatic Technique in 1,000 Neuro-Monitored Thyroidectomies
title_full_unstemmed Comparison of Surgical Complications Rates Between LigaSure Small Jaw and Clamp-and-Tie Hemostatic Technique in 1,000 Neuro-Monitored Thyroidectomies
title_short Comparison of Surgical Complications Rates Between LigaSure Small Jaw and Clamp-and-Tie Hemostatic Technique in 1,000 Neuro-Monitored Thyroidectomies
title_sort comparison of surgical complications rates between ligasure small jaw and clamp-and-tie hemostatic technique in 1,000 neuro-monitored thyroidectomies
topic Endocrinology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8058413/
https://www.ncbi.nlm.nih.gov/pubmed/33897619
http://dx.doi.org/10.3389/fendo.2021.638608
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