Clinical Science
Post-thyroidectomy complications. The role of the device: bipolar vs ultrasonic device: Collection of data from 1,846 consecutive patients undergoing thyroidectomy

https://doi.org/10.1016/j.amjsurg.2015.05.024Get rights and content

Highlights

  • The study involve 1,846 subjects submitted to thyroidectomy performed by ultrasonic/bipolar forceps.

  • RLN paralysis is lower when an ultrasonic device is employed compared with the bipolar forceps.

  • Patients are at greater risk of developing hypocalcemia if a central neck dissection is performed.

  • Finally, these results may aim about which devices to use in thyroid surgery.

Abstract

Background

Specific complications after thyroid surgery, such as recurrent laryngeal nerve injury (RLN) or hypoparathyroidism, are feared because they may give rise to a lifelong disability for the patient. The aim of this study was to evaluate the possible association between the types of device used (bipolar vs ultrasound-based harmonic scalpel defined Harmonic Focus) and major postoperative complications.

Methods

During a 1-year period, between October 2010 and October 2011, Italian Endocrine Surgery Units affiliated with the Italian Endocrine Surgery Units Association collected data on all consecutive patients older than 18 years who had undergone primary total thyroidectomy, near total thyroidectomy, and completion thyroidectomy. The data were included in a dataset, listing demographic variables, details on the surgical procedure, and 2 major complications of the thyroid surgery: postoperative RLN palsy/hypomobility and hypocalcemia.

Results

Our population comprised 1,846 subjects (78.6% women, median age 52 years). Six hundred four (32.7%) subjects underwent thyroidectomy by bipolar forceps and 1,242 (67.3%) by ultrasonic device. The risk of hypocalcemia in subjects undergoing thyroidectomy by ultrasonic device was similar to those undergoing thyroidectomy by bipolar after adjusting for sex, type of thyroidectomy, and central lymphadenectomy (odds ratio .94, 95% confidence interval .76 to 1.17). Subjects who underwent thyroidectomy by ultrasonic device had a lower risk of RLN paralysis compared with those undergoing thyroidectomy by bipolar forceps also after adjusting for central lymphadenectomy (odds ratio .39, 95% confidence interval .2 to .7).

Conclusion

This multicenter study acknowledges the value of the ultrasonic device as a protective factor only for RLN palsy, confirming nodal dissection as a risk factor for postoperative hypocalcemia and vocal folds disorders.

Section snippets

Patients and Methods

During a 1-year period, between October 2010 and October 2011, all consecutive patients older than 18 years undergoing primary TT, near total thyroidectomy (NTT), and completion thyroidectomy (CT) were prospectively followed up within 6 months from thyroidectomy, and underwent analysis regarding major postoperative complications. Data were collected from the Italian Endocrine Surgery Units affiliated with the Italian Endocrine Surgery Units Association where thyroid surgery is routinely

Demographics and surgical characteristics

Our population comprised 1,846 subjects (78.6% women, median age 52 [range 18 to 87] years); 604 (32.76%) subjects underwent thyroidectomy by bipolar forceps and 1,242 (67.3%) by ultrasonic device.

Histological evaluation after surgery showed benign thyroid diseases in 1,142 (61.8%) patients and malignant disease in 612 (33.2%). This information was missing in 92 subjects (5%). TT was performed on 1,636 subjects (88.6%), while 141 (7.6%) underwent NTT and 57 (3.1%) CT. In 12 subjects (.7%) the

Comments

A different risk of complications following thyroidectomy by ultrasonic device or bipolar forceps has been postulated, even in a recent study.13

Voice alterations after uncomplicated thyroidectomy include a broad spectrum of symptoms that are usually temporary and resolve relatively quickly.14, 15 Several causes have been suggested, including orotracheal intubation16; modification of the vascular supply and venous drainage of the larynx17; cricothyroid dysfunction16, 17; laryngotracheal fixation

Conclusions

These results may offer clinically important implications on surgical decisions, policy making, and guideline formation with regards to the use of hemostatic devices in thyroid surgery.

Finally, on the basis of our results the appropriate informed consent remains a priority to emphasize particularly the importance of some primary factors responsible for the increased risk of RLN after thyroid surgery, regardless of the device used.

Acknowledgments

Participating investigators:

Italian Endocrine Surgery Units affiliated with the Italian Endocrine Surgery Units Association enrolled, selected, and then operated patients required for the study:

Josè Luis Novelli, Centro de la Tiroides. Rosario, Argentina—Gianlorenzo Dionigi, Università dell'Insubria, Varese—Anselmo Arlandini, Ospedale Galliera, Genova—Guido Gasparri, Nicola Palestini, Università di Torino—Rocco Bellantone, Celestino Pio Lombardi, Guglielmo Ardito, Endocrinochirurgia, Università

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    The authors claim that the manuscript was never presented as a previous communication to a society or meeting.

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