Clinical SciencePost-thyroidectomy complications. The role of the device: bipolar vs ultrasonic device: Collection of data from 1,846 consecutive patients undergoing thyroidectomy
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
References (29)
- et al.
Comparison of LigaSure vessel sealing system, harmonic scalpel, and conventional hemostasis in total thyroidectomy
Otolaryngol Head Neck Surg
(2009) - et al.
Early prediction of hypocalcemia after thyroidectomy using parathyroid hormone: an analysis of pooled individual patient data from nine observational studies
J Am Coll Surg
(2007) - et al.
Randomized clinical trial on Harmonic Focus shears versus clamp-and-tie technique for total thyroidectomy
Am J Surg
(2011) - et al.
Acoustic analysis of the speaking voice after thyroidectomy
J Voice
(1997) - et al.
Voice changes after thyroidectomy recurrent laryngeal nerve injury
J Am Coll Surg
(2004) - et al.
Phonatory characteristics of patients undergoing thyroidectomy without laryngeal nerve injury
Otolaryngol Head Neck Surg
(1997) - et al.
A randomized, prospective, parallel group study comparing the Harmonic Scalpel to electrocautery in thyroidectomy
Surgery
(2005) - et al.
Prognostic factors for definitive hypoparathyroidism following total thyroidectomy
Acta Otorrinolaringol Esp
(2008) - et al.
Simultaneous comparison of multiple treatments: combining direct and indirect evidence
BMJ
(2005) - et al.
Complications of thyroid surgery: how to avoid them, how to manage them, and observations on their possible effect on the whole patient
World J Surg
(2000)
Hypocalcemia following thyroid surgery: incidence and risk factors. A longitudinal multicenter study comprising 2,631 patients
Endocrine
Complications of thyroid surgery: analysis of a multicentric study on 14,934 patients operated on in Italy over 5 years
World J Surg
Complications to thyroid surgery: results as reported in a database from a multicenter audit comprising 3,660 patients
Langenbecks Arch Surg
The use of “harmonic scalpel” versus “knot tying” for conventional “open” thyroidectomy: results of a prospective randomized study
Langenbecks Arch Surg
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Parathyroid hormone level after total thyroidectomy using conventional versus harmonic focus technique: Prospective randomized study
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There were no relevant financial relationships or any sources of support in the form of grants, equipment, or drugs.
The authors claim that the manuscript was never presented as a previous communication to a society or meeting.