Comparison of effects of energy based devices on quality of life after sutureless thyroidectomy.

OBJECTIVE: In current literature, no studies evaluated effect of energy-based vessel-sealing-devices on quality of life after sutureless total thyroidectomies. This study aimed to identify any potential differences between two energy-based vessel-sealing-devices (Harmonic Focus, Ligasure LF1212) in patients with benign thyroid disorders who underwent sutureless total thyroidectomy. MATERIALS AND METHODS: Differences in quality of life of patients were evaluated using data obtained by Thy-PRO-39-Tr questionnaire prior to and four-week after surgery. Total and domain-based alterations in quality of life were compared between groups according to energy-based vessel-sealing-devices type (Group L, Group H). Additionally, data including demographics, height, weight, body mass index, neck circumference, sternomental distance were collected. RESULTS: Of 1032 patients, 200 were eligible for study, at the end 193 were analysed. There were no differences between groups in terms of age, sex, body mass index, tobacco use. Analysis did not reveal any differences in overall quality of life between groups (P = .42). However, in "eye symptoms" (P < .001) and "cognitive functions" (P = .002) domains, Harmonic provided statistically improved quality of life. Effect on cognitive function was greater in patients of advanced age. CONCLUSIONS: Especially in elderly patients with worsening eye conditions and cognitive functions, use of Harmonic may enhance patients' outcome by increasing quality of life in addition to optimizing surgical outcome when compared to Ligasure.

Transoral endoscopic thyroidectomy using a self-retaining retractor as an alternative to carbon dioxide gas insufflation: A comparative analysis of 131 cases.

Although transoral endoscopic thyroid surgery affords several advantages, the use of carbon dioxide (CO2) gas to create and maintain the working space may cause complications such as subcutaneous emphysema and a CO2 embolism. We have used a self-retaining retractor as an alternative to CO2 gas insufflation for some time; we here report its feasibility and safety. We reviewed the medical records of 131 patients who underwent transoral endoscopic thyroid lobectomy; we compared the "CO2 group" and the "retractor" group. All thyroid tumors were completely removed with negative surgical margins. No major complication occurred in the retractor group. Two major events occurred in the CO2 group: one case of permanent vocal cord palsy and one CO2 embolism. Significant subcutaneous emphysema of the neck and chest were noted in 17.7% of CO2 group patients, but in no retractor group patient. Wound infection occurred in one patient in each group but improved after appropriate management. The total operation times from incision to suture did not differ significantly between the two groups (p = 0.514). Transoral endoscopic thyroidectomy using a self-retaining retractor as an alternative to CO2 gas insufflation is feasible and safe. The superiority of transoral endoscopic thyroidectomy would be emphasized by avoiding CO2 gas insufflation, thus eliminating the risk of CO2 gas-related complications.

How we do it: 'tonsil swabs please' - an alternative use in open neck surgery.

BACKGROUND: Thyroid and parathyroid surgery often involves the use of heated instruments for dissection. Whilst these are beneficial, accidental thermal damage to the exposed skin edges can occur, resulting in an unsatisfactory cosmetic outcome. Tonsil swabs can be used in head and neck surgery intra-operatively to control bleeding. This paper describes an alternative use for them in protecting wound edges during the procedure. METHOD: Damp tonsil swabs are sutured onto the wound edges after the initial skin incision. They remain present for the duration of the surgery and are removed at the time of skin closure. RESULTS: The tonsil swabs provide protection and help avoid accidental injury to the skin. No complications with this technique have been experienced. CONCLUSION: This paper describes a simple, effective and practical technique for protecting the skin during neck procedures using resources readily available in a standard ENT operating theatre.

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 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.

Effect of energy-based devices on post-operative parathyroid function and blood calcium levels after total thyroidectomy.

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.

Detailed comparison of the da Vinci Xi and S surgical systems for transaxillary thyroidectomy.

ABSTRACT: Robotic surgical systems have evolved over time. The da Vinci Xi system was developed in 2014 and was expected to solve the shortcomings of the previous S system. Therefore, we conducted this study to compare these 2 systems and identify if the Xi system truly improves surgical outcomes.In this retrospective study, a total of 86 patients with unilateral papillary thyroid carcinoma without central lymph node involvement underwent gasless transaxillary hemithyroidectomy using 2 robotic systems, the da Vinci S and Xi. Forty patients were in the da Vinci S group and 46 patients were in the da Vinci Xi group. All surgeries were performed by 1 surgeon (YWC). All surgery video files were analyzed to compare the duration of each surgical step.The total operation time was significantly shorter in the Xi group than in the S group (153.0 minutes vs 105.7 minutes, P < .01). Time for robot docking was shorter in the Xi group (19.8 minutes vs 10.6 minutes, P < .01), and all procedures performed in the console also required a shorter time in this group. The overall complication rate did not differ significantly (P = .464).The da Vinci Xi system made robotic thyroidectomy easier and faster without increasing the complication rate. It is a safe and valuable system for robotic thyroidectomy.

The usefulness and utilization of a detachable steel wire-rimmed retractor (KN retractor) for endoscopic thyroid and parathyroid surgery.

PURPOSE: In endoscopic surgery, surgeons occasionally encounter difficulties due to visual field obstruction by muscles or blood vessels. In these situations, specialized instruments that can effectively retract these obstructions are required. Recently, we developed a new detachable wire-rimmed retractor (KN retractor) for narrow-space surgery. METHODS: We evaluated the utility of this KN retractor in 15 patients with thyroid and parathyroid disease. Of those, five patients with papillary thyroid cancer had gasless endoscopic hemithyroidectomy with central node dissection, five underwent endoscopic total thyroidectomy for Graves' disease, and the remaining five received endoscopic parathyroidectomy with gas insufflation. RESULTS: Surgeons were able to perform meticulous operations in a satisfactory visual field supported by the KN retractor. In all patients, the strap muscles were preserved without cutting. The average operating time was 149, 154, and 81 min in patients who underwent hemithyroidectomy with central node dissection, total thyroidectomy, and parathyroidectomy, respectively. Gas insufflation was successfully completed in all cases while maintaining sufficient airtightness. CONCLUSIONS: The KN retractor is suitable for both the gasless lifting method and gas insufflation surgery in a narrow space. We believe that the KN retractor is a new device that will greatly improve the safety and shorten the operation time in endoscopic surgery.

Anatomic Variations From 120 Mental Nerve Dissections: Lessons for Transoral Thyroidectomy.

BACKGROUND: Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a promising technique for eliminating a neck incision. A new risk of TOETVA is the potential for injury to the mental nerves during placement of three oral endoscopic ports. A better understanding of the variations in mental nerve anatomy is needed to inform safer TOETVA technique. MATERIALS AND METHODS: We performed 120 dissections of mental nerve branches exiting the mental foramen in 60 human cadavers. Anatomic distances and relationships of the foramen to the midline were evaluated. Mental nerve branching patterns were studied and compared with previously reported classification systems to determine surgical safe zones free of nerve branches. RESULTS: The mean midline-to-mental foramen distance was 29.2 ± 3.3 mm, with high variability across individuals (18.8-36.8 mm). There were differences in this distance between the left and right foramina (29.8 ± 3.2 versus 28.8 ± 3.3 mm, P = 0.03). All mental nerve branches exiting the mental foramen distributed medially. The branching patterns were classified into eight distinct categories, three of which are previously undescribed. One of these novel patterns, occurring in 9.2% of cases, had a dense and wide clustering of branches traveling toward the midline. CONCLUSIONS: The location of the mental foramen and mental nerve branching patterns demonstrate high variability. To avoid mental nerve injury in TOETVA, we identify a safe zone for lateral port placement lateral to the plane of the mental foramen. Placement and extension of the middle port incision should proceed with caution, as clustering of mental nerve branches in this area can frequently be present.

Consequences of Trocar Dynamics on Mental Nerve in Transoral Thyroidectomy.

BACKGROUND: Mental nerve (MN) injuries are reported during transoral endoscopic thyroidectomy vestibular approach. Effect of trocar insertion and position on MN are examined in the present study. MATERIALS AND METHODS: Ten millimeter incision was made at the center of the lower lip oral vestibule. Two 5 mm lateral incisions of the lower lip oral vestibule were made at the junction between the incisor and the canine. These 2 lateral incisions were high, just below the edge of lower lip. Nine pigs (18 MN) were randomly divided into 3 groups and MN dissection was performed. The angle between the lateral ports and median line were changed between 15 and 45 degrees among 3 groups and effect on MN was examined. RESULTS: During dissection when insertion and other ports are in neutral position visual inspection of MNs did not reveal any compression bilaterally. The distance between MN and the ports was 18.2±2.1 mm (16.3 to 21.2 mm). In group I and group II, MNs have no compression by the lateral trocars. In group III (45 degrees), left MNs were all compressed. Two MNs (66.7%) were compressed on the right side. The MN was compressed at its ramification. CONCLUSIONS: The results of the present experimental study, endorse the suggested medial and lateral vestibular incisions for transoral endoscopic thyroidectomy vestibular approach. However, during dynamic modification of the lateral port position/angle, MN compression was observed when the angle was >45 degrees.

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.

BACKGROUND: The benefits of using energy devices (EDs) such as ultrasonic coagulating shears or electrothermal bipolar vessel sealing devices for thyroid cancer surgery have been evaluated only with limited data obtained from small samples. MATERIALS AND METHODS: Using a Japanese national inpatient database, we identified 59,394 patients with thyroid cancer who underwent thyroidectomy without EDs (without-ED group, n = 32,360) and with EDs (with-ED group, n = 26,764) from July 2010 to March 2017. One-to-one propensity score matching was performed to compare the occurrence of postoperative complications including recurrent laryngeal nerve paralysis and chyle leakage, duration of anesthesia, length of stay, total costs, in-hospital mortality rate between the two groups. We also performed multivariate regression analyses using a generalized estimating equation and multiple imputation as a sensitivity analysis. RESULTS: In the propensity-matched analysis involving 22,108 pairs, no significant differences were found in any postoperative complications (7.4% vs. 7.3%, p = 0.73), duration of anesthesia (217 min vs. 218 min, p = 0.54), length of stay (8.7 days vs. 8.2 days, p = 0.07) and in-hospital mortality rate (0.07% vs. 0.09%, p = 0.61). Compared with the without-ED group, the with-ED group showed a lower occurrence of postoperative recurrent laryngeal nerve paralysis (2.3% vs. 2.7%, p = 0.01) but a higher occurrence of postoperative chyle leakage (0.3% vs. 0.1%, p < 0.001) and total cost (US $7246 vs. US $6937, p < 0.001). The multivariate regression analysis showed compatible results with the propensity-matched analysis. CONCLUSION: In this large nationwide cohort of patients with thyroid cancer, no significant difference was detected in the proportions of any complications. The use of EDs was associated with a lower occurrence of postoperative recurrent laryngeal nerve paralysis but a higher occurrence of postoperative chylothorax and higher cost.

Foley Balloon Facilitates Creation of Working Space in Transoral Thyroidectomy.

BACKGROUND: Transoral thyroidectomy via the vestibular approach retains no scars in the body surface and is a good option for patients indicated for thyroidectomy but with cosmetic concerns. However, the working space of this procedure is relatively small and is also difficult to create compared with that of other remote-access thyroidectomy procedures. METHODS: In this study, we first created a tract from the chin to the sternal notch, after which a Foley catheter with stylet was inserted through the middle oral incision. Sequential balloon insufflations were performed to dilate the entire subplatysmal tunnel. RESULTS: After Foley catheter dilatation, the subplatysmal space was larger, and subsequent trocar insertion became much easier. With the help of a balloon compressing the surrounding tissue, hemostasis was secured and a clearer tissue plane could be identified for subsequent sharp dissection. CONCLUSIONS: Foley balloon dilatation is a simple, effective, and low-cost technique that overcomes the difficulty in creation of working space during the initial stage and can be applied to all transoral thyroidectomy procedures.

The value of acoustic respiratory rate monitoring in a patient with postoperative hemorrhage after thyroidectomy: a case report.

Acoustic respiratory rate (RRa) monitoring is a non-invasive method of monitoring respiratory rate in spontaneously breathing individuals. The aim of this report is to highlight the clinical utility of this monitoring system in post-thyroidectomy patients by presenting a case of respiratory compromise due to post-thyroidectomy hematoma, in which the alarm of the respiratory rate monitor alerted the nursing staff about the complication. A 61-year-old woman who uneventfully underwent right thyroid lobectomy for adenomatous goiter under general anesthesia with endotracheal intubation was being monitored postoperatively using the RRa monitoring system. The alarm of the monitor suddenly indicated tachypnea, with an increase in respiratory rate from 8 to 30 breaths/min over less than 3 min, although with normal oxygenation (SaO2 99%). Physical examination revealed the presence of a hematoma due to postoperative bleeding, which was emergently treated surgically under general anesthesia with awake videolaryngoscopy-assisted endotracheal intubation, with adequate preparations for emergency tracheostomy, if required. Videolaryngoscopy before the intubation revealed mild laryngopharyngeal edema and tracheal displacement, although awake endotracheal intubation could be easily performed with a metallic tube. Thereafter, after anesthesia induction, the hematoma was drained, hemostasis was achieved, and the wound was closed after surgical drain insertion. The patient was extubated postoperatively without any further respiratory events. The information on respiratory rate disorders provided by RRa monitoring, including the tachypnea alarm, can contribute to early detection of postoperative respiratory complications and to avoiding life-threatening situations following certain operations, such as thyroidectomy.

Stimulating and dissecting instrument for transoral endoscopic thyroidectomy: proof of concept investigation.

OBJECTIVES/HYPOTHESIS: Intraoperative neuromonitoring (IONM) is a useful adjunct for recurrent laryngeal nerve (RLN) mapping and identification in transoral endoscopic thyroidectomy vestibular approach (TOETVA). This experimental study aimed to investigate the feasibility, safety, thresholds required of an endoscopic forceps that combine the function of surgical dissection and nerve stimulation. STUDY DESIGN: Prospective experimental research. METHODS: TOETVA was performed in 12 piglets, i.e., 24 RLNs and 24 vagal nerves (VN). RLNs electromyography (EMG) was recorded via endotracheal surface electrodes. Baseline EMG of VN and RLN were recorded and compared by (a) percutaneously placed monopolar stimulator probe (Group I), (b) adapted Maryland endoscopic dissector applied on nerves at its tip-end (Group II) and (c) endoscopic dissector tip-lateral applied (Group III). EMG profiles, amplitude, latency, waveform, thresholds and supra-maximal stimulation (5 mA) were analyzed. RESULTS: Application of the endoscopic device was feasible in all TOETVA and did not result in any morbidity. 24 RLNs and VNs were detected, stimulated and monitored. With increase of stimulation current, the amplitude of EMG increased, showing a dose-response curve. Mean VN stimulation thresholds were: Group I 0.28 mA, Group II 0.56 mA, Group III 0.58 mA (P1 = 0.00, P2 = 0.00, P3 = 0.11). Minimal current to evoked a maximal VN response was: Group I 0.65 mA, Group II 1.07 mA and Group III 1.14 mA (P1 = 0.00, P2 = 0.00, P3 = 0.48). Minimal current to evoke a RLN maximal response was Group I 0.6 mA, Group II 0.95 mA and Group III 1.05 mA (P1 = 0.00, P2 = 0.00, P3 = 0.31). Latency values were similar to each group. Repetitive (> 10 min) supra-maximal (> 5 mA) electrical stimulation was safe. CONCLUSIONS: The application of endoscopic stimulating dissector is simple, effective and safe way to monitor both VN and RLN function during a TOETVA animal model. It provides surgeons with real-time feedback of EMG response and can be applied as a tool for RLN monitoring. Endoscopic instrument required higher current to evoke EMG response compared to hand probe stimulation. Tip-end required less current to evoke EMG response compared to tip-lateral mode of stimulation.

Printing a Three-Dimensional Patient-Specific Safety Device for Reducing the Potential Risk of Mental Nerve Injury During Transoral Thyroidectomy.

BACKGROUND: Thyroidectomy transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a safe and cosmetically appealing alternative for well-selected patients undergoing thyroidectomy. However, during TOETVA, placement of the two lateral trocars and/or manipulation of the surgical instruments through the trocars may potentially injure and/or compress the mental nerve (MN) because the actual location of the nerve foramen may vary among individuals. The MN injury rate was reported to be as high as 75% in the initial period of robotic-assisted TOETVA. To reduce the potential risk of MN injury, we implemented a three-dimensional printing technology to develop a safety device for TOETVA. METHODS: The patient-specific safety device (PSSD) was a brace with an exact fit to the lower teeth and two safety markers on each side to indicate the location of the mental foramen. For patient in whom the brace would not be applicable, a 3D mandibular model was printed as a PSSD instead. We analyzed 66 patients undergoing TOETVA at our institution from March 2017 to March 2019. The preoperative details and complication profiles were also analyzed. RESULTS: With incorporation of the PSSD into our TOETVA procedure, there have been no cases of MN injury. CONCLUSIONS: Our own TOETVA series has demonstrated that the implementation of the PSSD has been successful in preoperatively identifying and preventing the potential risk of MN injury. Although the additional requirements of preoperative CT and time for fabricating the device impose limitations, the influence of the PSSD in TOETVA is positive.

Upgraded bidirectional approach video-assisted neck surgery (BAVANS) using a rigid endoscope with variable viewing direction for advanced endoscopic lymph node dissection in thyroid cancer patients.

In 2011, we developed bidirectional approach video-assisted neck surgery (BAVANS) for endoscopic thyroid cancer surgery. BAVANS combines two different approach pathways at 180 degrees to the cervical lesion for endoscopic thyroidectomy and complete cervical lymphadenectomy. We reported previously that the cranio-caudal approach is extremely useful for endoscopic complete lymph node dissection around the trachea. In 2014, we upgraded the initial BAVANS for better maneuverability and quality of lymph node dissection. A new high-tech rigid endoscope with a variable viewing direction (EndoCAMeleon™), has enabled us to reduce the camera port in the anterior neck while keeping the easy maneuverability and the same quality of central lymph node dissection (LND) as with the initial BAVANS. Endoscopic thyroid cancer surgery is now evolving concurrently with new visual technology.

Monobloc Total Thyroidectomy Using Sealing Devices: Preliminary Results and Comparative Analysis.

Background: The desire for perfect haemostasis has led the medical equipment industry to produce ideal instruments for safe thyroidectomy. Thus, haemostasis and sealing instruments such as the LigaSureTM Small Jaw, ThunderbeatTM Open Fine Jaw and HarmonicTM Focus have been indicated for thyroid surgery. Aim: The purpose of this study is to present the initial results of using these three surgical instruments for performing monobloc thyroidectomy. Material and Methods: We performed a prospective study between January 2014 and July 2019 in which we included all the patients operated by same surgeon using those 3 sealing devices. Thyroidectomies were performed using LigaSureTM Small Jaw (group 1), the ThunderbeatTM Open Fine Jaw (group 2) and HarmonicTM Focus (group 3). The groups were statistically compared in term of duration of surgery and hospitalisation, early postoperative complications as well as voice alteration or acute respiratory failure. Results: No significant differences were observed among groups in terms of patient demographics, pathological diagnoses, postoperative complications, length of hospitalization, and clinical outcomes. Operating time was shorter in group 1. Conclusions: New surgical instruments have beneficial properties, including shortening the operative time, maintaining a clean operating field, and minimising smoke released during the operation.

Comparing the Utility and Surgical Outcomes of Harmonic Focus Ultrasonic Scalpel with Ligasure Small Jaw Bipolar Device in Thyroidectomies: A Prospective Randomized Controlled Trial.

BACKGROUND: Ultrasonic or bipolar radiofrequency energy devices are routinely used for dissection and hemostasis during thyroidectomy. We report a single-center, prospective, randomized controlled trial comparing the utility and outcomes of Harmonic Focus, an ultrasonic coagulating shear device (UCSD), versus Ligasure Small Jaw, an electrothermal bipolar vessel sealer (EBVS) in thyroidectomy (NCT01765686). METHODS: Between December 2012 to January 2016, eligible patients were randomized to undergo hemithyroidectomy using either a UCSD or an EBVS. The primary outcome was duration of surgery. Secondary outcomes included blood loss, postoperative complications, ease of device use, ease of device set-up, vocal cord function, postoperative wound drainage, pain score, and adverse events. RESULTS: Of 110 patients assessed for eligibility, 100 were randomly allocated (UCSD: 49 patients; EBVS: 51 patients) and analyzed by intention-to-treat. There were no differences in specimen delivery time, total duration of surgery, wound drainage, and adverse events between the two groups. The UCSD group had a greater proportion of patients with higher postoperative pain scores in the first 72 h (8.1% vs. 2.0%, p = 0.043). Surgeons reported greater ease of use for the UCSD (49% vs. 27%; p = 0.005), while operating room staff favored the EBVS (60% vs. 33%, p = 0.005). CONCLUSIONS: Energy devices are equally effective in reducing thyroidectomy operative times, with no differences in the duration of surgery, drainage, or adverse events. Use of the UCSD was associated with higher postoperative pain scores, but was favored by the surgeons, likely due to the ability to perform fine dissection with the device itself.

Comparing Hematoma Incidence between Hemostatic Devices in Total Thyroidectomy: A Systematic Review and Meta-analysis.

OBJECTIVE: Alternative energy devices have become a popular alternative to conventional hemostasis in thyroid surgery. These devices have been shown to reduce operative time and thermal nerve injury. As hemostasis is paramount in thyroid surgery, we sought to examine the relative efficacy of 2 alternate energy devices compared to conventional hemostasis in preventing postoperative hematoma following total thyroidectomy. DATA SOURCES: Ovid MEDLINE, EMBASE, PubMed, and Cochrane Central Register of Controlled Trials. REVIEW METHODS: A systematic literature search was performed for all relevant English-language studies published between 1946 and July 2018. Two authors independently extracted data and analyzed articles for quality using the National Institute of Health Quality Assessment Scale. Our primary outcome of interest was hematoma requiring reoperation. RESULTS: A total of 348 studies were screened, with 23 meeting the inclusion criteria. We found no significant difference in postoperative hematoma rates using alternate energy devices compared to conventional hemostasis (P = .370, .317). Network meta-analysis echoed the results of conventional meta-analysis, demonstrating no significant difference in hematoma rates. CONCLUSIONS: We found no significant difference in postoperative hematoma rates following total thyroidectomy for any indication with the use of alternate energy devices compared to conventional hemostatic techniques. This suggests that hematoma occurrence does not necessarily need to be considered when choosing between these hemostatic devices. This information may help guide surgeons' decisions regarding choice of hemostatic technique during thyroid surgery.

Comparison Of The Effects Of Focus Harmonic Scalpel And Conventional Haemostasis On Parathyroid Function In Thyroid Surgery.

BACKGROUND: Protection of parathyroid is very important in thyroid surgery. Our aim was to compare the effect of Focus Harmonic Scalpel and Conventional Haemostasis on parathyroid function in thyroid surgery. METHODS: To analyse the clinical data of patients in our hospital from November 2011-December 2015 retrospectively. Operations have been performed with Focus Harmonic Scalpel in thyroid surgery since May 2013. Seventy-four patients with nodular goitre constituted Harmonic Scalpel group and Conventional Haemostasis group, and so did 139 patients with thyroid papillary carcinoma. Clinical data were compared such as age, gender, thyroid volume, operation procedure, preoperative parathyroid hormone and serum calcium concentration between the two groups. The differences between the two groups were observed in serum calcium concentration, parathyroid hormone concentration, incidence of transient hypocalcaemia and hypoparathyroidism after operation. RESULTS: The preoperative data showed no significant difference between Harmonic Scalpel group and Conventional Haemostasis group. No significant difference existed in postoperative clinic data at six a.m. the first day after operation between the two groups for patients with nodular goitre. The incidence of transient hypoparathyroidism and hypocalcaemia in Harmonic Scalpel group were less than that in Conventional Haemostasis group in thyroid surgery. Significant differences existed in the mean of serum calcium concentration and incidence of transient hypocalcaemia between the two groups for thyroid papillary carcinoma statistically. CONCLUSION: Focus Harmonic Scalpel has certain advantages than conventional Haemostasis in protecting parathyroid glands, reducing the incidence of transient hypoparathyroidism and hypocalcaemia in thyroid surgery, especially for patients with thyroid cancer.

Use of Alexis retractor in thyroid and parathyroid surgery. / Uso de retractor Alexis en cirugía de tiroides y paratiroides.

In thyroid and parathyroid surgical procedures, good visibility of the thyroid gland is essential. This is traditionally achieved by means of traction sutures of the dermo-plastysmal flaps to the drapes of the operative field, producing tension and even damage to the skin. The Alexis® retractor ring improves exposure and facilitates stable access to the thyroid, protecting the skin from injury during the intervention.