There is no reason to believe, at this point, that reduction in leak rates occur because reinforcement is used. Because the leak rate is small, the routine reinforcement of the staple line after sleeve gastrectomy is questionable at best, although a decrease in hemorrhage has been reported.

Hypothesis: New hemostatic methods have been widely used in open and laparoscopic surgery. The LigaSure Precise diathermy system (Valleylab, Boulder, Colo) has been recently used in thyroid surgery. We hypothesized that its use could lead to reduced operative time and fewer complications compared with conventional knot tying in total or near-total thyroidectomy. Design: Prospective case-controlled study. Setting: Tertiary care private hospital. Patients: Eighty patients underwent total or near-total thyroidectomy by 1 surgeon. Interventions: Forty patients underwent thyroidectomy with the conventional knot tying technique and 40 patients with the LigaSure diathermy system. Main Outcome Measures: Demographics, histopathological diagnosis, operative time, intraoperative blood loss, complications, and cost, using 2 test and Wilcoxon rank sum test.Results: The study groups had similar demographic and histopathological characteristics. The mean ± SD operative time was nonsignificantly reduced in the LigaSure group compared with the conventional knot tying group (84 ± 6 vs 89 ± 7 minutes, P = .60). The mean ± SD intraoperative blood loss was less for the LigaSure group (30±5 vs 35±8 mL, P =.36). There was 1 case of transient recurrent laryngeal nerve palsy in the LigaSure group. One patient from this group and 2 patients from the other group exhibited transient hypocalcemia; permanent postoperative hypocalcemia was not encountered in either group. The cost of the LigaSure diathermy system was significantly greater than that of conventional knot tying.Conclusion: Use of the LigaSure in thyroid surgery did not significantly reduce operative time, blood loss, or complication rates compared with conventional knot tying, but it increased operative cost.

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Laparoscopic cholecystectomy is safe and is not associated with a higher incidence of BDI than OC. Moreover, we did not find that the learning curve for LC affected BDI occurrence.