Background: Hemostasis is fundamental in thyroid surgery. The aim of this randomized active comparator-controlled study was to compare the effectiveness of Ligasure TM Exact to previously existing sealing devices in patients undergoing thyroidectomy.Methods: A total of 180 patients were randomly allocated into 4 groups according to the hemostatic device used: Focus Harmonic Scalpel ® (FHS), Ligasure TM Small Jaw (LSJ), Thunderbeat ® (TB), and Ligasure TM Exact (LE). We recorded epidemiologic and biochemical data, operative difficulty, postoperative vocal alteration and pain, complications, operating time, grams of gland excised per minute, and hospitalization.Results: Differences (P<0.001) were observed concerning duration of surgery, operative difficulty and quantity of gland removed per minute. Concerning duration of surgery it is shorter for LE followed by TB and then by both FHS and LSJ. Concerning the quantity of thyroid removed per minute LE leads, followed by FHS and TB. The least amount of gland removed per minute is by LSJ. Finally, operative difficulty was less for LE, while it was equal for all other three devices.Conclusions: Energy devices are now frequently used in thyroidectomy. Comparing these devices seems to qualify them as equal concerning post-operative complications, hemostasis, and acute inflammatory reaction.However, Ligasure TM Exact Dissector seems to have better results concerning duration of surgery, quantity of thyroid tissue removed per minute and intraoperative difficulty.

Introduction Anastomotic leakage (AL) after low anterior resection for rectal cancer is a severe complication. Except for re‐operation, several endoscopic options have been proposed for the minimal invasive treatment of AL, including the endoluminal vacuum devices, tissue sealants and Over‐The‐Scope‐Clip (OTSC) technique. The aim of the present review is to evaluate the effect of alternative treatment options for AL repair, by means of endoscopy. Method A bibliographic search was performed in the international literature. Ten case reports and series were finally included, reporting 75 cases of endoscopic repair of AL. A descriptive statistical analysis and a systematic review were performed. Results The patients' mean age was 65.84 ± 9.92 years (95% CI: 61.70‐68.76), the male‐to‐female ratio being 1.5:1. The mean diameter of the cavity was 5.17 ± 3.32 cm (95% CI: 4.03‐6.31). The mean time until the diagnosis was 44.15 ± 105.91 days (95% CI: 13.39‐74.90). Vacuum‐assisted closure therapy was the most common technique (52%), followed by fibrin glue (25.3%) and OTSC (22.7%). As supplementary therapy, OTSC was applied in 8.3%, vacuum‐assisted closure in 25%, endoclips in 4.2%, while fibrin glue was the most frequently used (62.5%). Conclusion Endoscopic management of AL after low anterior resection is considered as an alternative to surgical treatment with promising results.

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