Comparison of Surgical Complications Rates Between LigaSure Small Jaw and Clamp-and-Tie Hemostatic Technique in 1,000 Neuro-Monitored Thyroidectomies

Abstract

Over the past decade, the use of neuromonitoring in thyroid surgery has become well established and is increasing accepted across the world. In addition, new developments in energy devices have significantly improved efficacy in achieving hemostasis in thyroid surgery. Few studies focused on the complication rates in energy device-assisted sutureless neuro-monitored thyroidectomy. This study investigates a novel LigaSure Small Jaw (LSJ) technique for sutureless thyroidectomy and compares the surgical complication rates between LSJ and conventional clamp-and-tie technique in one thousand consecutive neuro-monitored thyroidectomy patients. Five hundred patients received sutureless thyroidectomy performed with LSJ (Group L), and 500 patients received surgery performed with conventional clamp-and-tie technique (Group C). Complication rates of postoperative hematoma, hypocalcemia and recurrent laryngeal nerve (RLN) palsy were compared between groups. The overall complication rates of hematoma, hypocalcemia (temporary/ permanent), and RLN (temporary/ permanent) palsy were 0.9%, 24.9% (24.6%/0.3%), and 1.7% (1.5%/0.2%), respectively. Group L and Group C significantly differed in postoperative hematoma rate (0.0% vs. 1.8%, respectively; p = 0.0026) and in postoperative hypocalcemia rate (20.1% vs. 30.0%, respectively; p = 0.0032). The incidence of RLN palsy did not significantly differ between Group L and Group C (1.38% vs. 2.08%; p = 0.2652). The overall surgical complication rates are low in neuro-monitored thyroidectomy. The LSJ is feasible for performing completely sutureless thyroidectomy and obtains superior outcomes of postoperative hematoma and hypocalcemia in comparison with clamp-and-tie hemostatic technique. The novel LSJ technique using double or overlapped sealing is useful for sutureless thyroidectomy. However, surgeons must carefully observe the tissue contraction that may reduce the LSJ-RLN distance and increase the risk of thermal injury during the LSJ activation.

Prognostic Indicators of Non-Transection Nerve Injury and Vocal Fold Motion Impairment After Thyroid Surgery – Correlation Between Intraoperative Neuromonitoring Findings and Perioperative Voice Parameters

“…3) All patients with thermal RLN injury in this study had unrecovered VFM (U Group). RLN thermal injury is difficult to be detected visually and the risk of permanent palsy is high, surgeons should maintain vigilance in modern thyroid surgery that increases the use of energy-based devices ( 24 ). Compared to relatively mild mechanical injuries, thermal injuries sustained during surgery may require earlier voice intervention ( 25 ) performed under comprehensive postoperative laryngofiberscopy and voice analysis.…”

Improving Voice Outcomes After Thyroid Surgery – Review of Safety Parameters for Using Energy-Based Devices Near the Recurrent Laryngeal Nerve

“…However, the nerve injury mechanisms are significantly differed between the two groups. No patients in the clamp-and-tie group had thermal injury, whereas one-third of patients in the EBD group suffered thermal injury caused by lateral thermal spread in palsied RLNs (6).…”

“…Most intraoperative thermal injuries to the RLN result from thermal spread during use of high-temperature electrocautery devices and EBDs. Tissue contraction during EBD activation increases the risk of thermal injury because it reduces the distance from the RLN at which an EBD can be safely used (6). Thermal injury to the RLN often occurs unexpectedly when an EBD is activated or used for dissection.…”

“…Reported intraoperative advantages of EBDs include considerably decreased operative time, incision length and blood loss. Other clinically significant advantages of EBDs over conventional techniques include the superior postoperative outcomes of EBDs, e.g., reduced pain, wound drainage, neck hematoma, and hypocalcemia (1,2,5,6).…”

Training Courses in Laryngeal Nerve Monitoring in Thyroid and Parathyroid Surgery- The INMSG Consensus Statement

“…Intraoperative neural monitoring (IONM) is now an integral aspect of thyroid surgery in many centers. Interest in IONM, the number of institutions that perform, and societies that recommended monitored thyroidectomies have increased throughout the world in recent years (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16). A recent international survey (16) of over 1,000 surgeons revealed that IONM is highly prevalent with 83% of surgeons using IONM in some or all of their cases.…”