Comparison of outcome of Sutureless Thyroidectomy by Ligasure small jaw verses conventional technique.

Abstract

ABSTRACT… Thyroid is a highly vascular gland and hemostasis is a key limiting factor in morbidity and mortality in thyroid surgery. Hemostasis has always been a challenge and various techniques have been used. Vessel sealers like Ligasure are now gaining popularity. Objectives: The objective of this study is to compare thyroidectomy by Ligasure with conventional technique in terms of mean operative time and post-operative blood loss. Study Design: It is a Randomized Control Trial. Setting: Surgical Department of Allied Hospital Faisalabad. Period: Six months (March 2017 to August 2017). Material & Methods: After approval of study from ethical review committee and informed consent, the patients were subjected to complete history and clinical examination in addition to baseline investigations. Total 135 patients of multinodular goiter (MNG) and euthyroid were divided in two groups by simple random sampling. All surgeries were performed under general anesthesia with orotracheal intubation and procedure offered to each patient was subtotal thyroidectomy. Both techniques were compared by measuring the time from opening of pretracheal fascia till its closure in minutes by stop watch and mean was calculated. Post operative blood loss was measured in graduated drain placed in thyroid bed for 24 hours. Results: Mean operative time was recorded as 62.11+4.07 minutes in Ligasure technique group and 73.05+4.01 minutes in conventional technique group. Mean blood loss was recorded as 57.28+3.42 ml in Ligasure technique group and 70.85+4.12 ml in conventional technique group. Conclusion: We concluded that mean operative time and post operative blood loss is significantly lower in cases undergoing thyroidectomy with Ligasure as compared to conventional technique. Article Citation: Akram M, Randhawa SR, Durr-i-Chaman, Zafar S, Yaqoob M, Irfan S, Sajid M. Comparison of outcome of Sutureless Thyroidectomy by Ligasure small jaw verses conventional technique.

Study of Using Ligasure Small Jaw versus Traditional Clamp and Tie technique in Thyroidectomy: A Comparative Study

“…Another study done by Grøndal et al (14) found that Using Ligasure in complete thyroidectomy instead of the more traditional suture ligation approach significantly decreased intraoperative blood loss. The same results were also obtained in a study performed by Akram et al (1) found that mean intraoperative blood loss was recorded to be 57.28 ml in the Ligature technique group and 70.854 ml in the conventional technique group, with a P-value of 0.0001, indicating a significant difference between the two groups.…”

“…Hemostasis of blood vessels can be performed using the time-tested Clamp and tie method or more modern methods like Ligasure, a form of bipolar surgical diathermy. The novel electro thermal bipolar tissue sealing device (Ligasure) has been used in many different surgical specialties, and other diathermy approaches have been presented to limit intraoperative blood loss (1) . Thyroid surgery necessitates precise and reliable hemostasis because of the proximity of the thyroid to vital structures such the carotid artery, jugular vein, and recurrent laryngeal nerve (RLN).…”

Comparison of outcome of conventional suture ligation versus ligasure vessel sealing in patients undergoing total thyroidectomy for multinodular goiter.

“…21 Similarly, Akram et al found that when thyroidectomy was conducted using Ligasure Small Jaw, the operational duration was reduced from 106 ± 23.5 minutes to 80 ± 12.4 minutes (P=0.006), compared to 106 ± 23.5 minutes for traditional suturing thyroidectomy. 22 Different other studies also have indicated mean operating times for complete thyroidectomy with Ligasure group , ranging from 58 minutes to 115.54 minutes, and mean operative durations for conventional vascular ligation approach ranging from 75 to 153.45 minutes. 3,4 Ozben et al concluded in their study that Ligasure vessel ligation is a safe approach for thyroid surgery with few problems, similar to our findings.…”

Frequency of post-operative pain in thyroid surgery with or without use of ligasure.

“…13 The variables of operative time 14 , intraoperative / postoperative blood loss and hospital stay 15 were discussed in many studies but very infrequent data regarding the post-operative pain. In our setting study already conducted on different variables 16 but for post-operative pain we conducted the current study.…”