Early experience with ligasure thyroidectomy in a Nigeria Teaching Hospital

Abstract

Background: The principles of safe and efficient thyroid surgery had been established and the technique has remained the same for over the century without any major significant changes. The introductions of electrosurgical devices constitute a major shift in the technique of thyroid surgery. Objective: We present our early experience with the use of LIGASURE vessel sealing system for the procedure of thyroidectomy. Materials and Methods: This was a quasi-experimental study comparing outcome of LigaSure thyroidectomy in a prospective nonrandomized cohort with another retrospective cohort of preintervention clamp-and-tie thyroidectomy. Results: A total of 30 patients with a clinical diagnosis of goiter were recruited into the study. There were two males and 28 females with a mean age of 42.6 years. Diagnosis was simple multinodular goiter 24 (80%), controlled toxic nodular goiter 3 (10%), grave disease 1 (3.3%), and multinodular goiter with retrosternal extension 2 (6.7%). The mean thyroid weight was 121.0 g. The mean duration of surgery was 59 min compared to 128 min for traditional technique ( P < 0.01). The mean blood loss of 116 ml was significantly less than 328 ml following the traditional technique ( P < 0.01). Mean duration of hospital stay was 1.9 days, compared to 3.55 days in the traditional technique group ( P = 0.02). Troubling postoperative complications of change in voice quality occurred in only one patient (3.3%). Conclusion: LigaSure thyroidectomy was found to be easier and faster to carry out with no learning curve and easy to learn and adapt.

Safety and Cost-effectiveness of LigaSure® in Total Thyroidectomy in Comparison with Conventional Suture Tie Technique

“…It provides effective hemostasis by sealing tiny blood vessel up to 7 mm in the bed of thyroid gland. In conventional suture tie thyroidectomy these vessels continue to ooze because they cannot be ligated for control of bleeding [27][28]. Since LigaSure operates at a lower temperature (80°F) as compared to other EBDs like Harmonic Focus, it causes reduced thermal damage [26][27].…”

“…Use of LigaSure in thyroid surgery significantly decreases risk of detrimental vascular and nerve damage. In comparison to conventional thyroidectomy, LigaSure vessel sealing system has been suggested to reduce operative time, RLN, and parathyroid injury [27].…”

Sutureless Total Thyroidectomy for Substernal Goiter: Amending Versus Unnecessary

“…Accomplishing meticulous hemostasis is essential to avoid serious complications yet the thyroid gland has been stated as a highly vascularized organ. Onwards of the recent introduction of various surgical energy devices such as LSJ vessel sealing systems and harmonic devices in order for the procedures of thyroidectomy, physicians have encountered some propounding advantages [15][16][17]. As such, some authors asserted that utilization of most used energy-based devices: (i) Ultrasonic Harmonic Focus Scalpel (HF), (ii) LSJ, and (iii) Thunderbeat Open Fine Jaw (TB) are effective and even safe in both hemostasis and dissection nearby the course of the inferior laryngeal nerve and even the suspensory Ligament of Berry.…”

Effect of the Trendelenburg position on the homeostasis during and post thyroidectomy

“…Based on the findings of the study by Qandili et al and a meta-analysis ( 22), the post-surgical drainage in thyroidectomy did not offer any significant advantage on seroma. Arowolo et al (24) reported two cases of seroma in 30 patients undergoing surgery. However, in the stated study, the head of bed was tilted upwards to 15 degrees in an opposite direction from the Trendelenburg position; moreover, thyroidectomy was performed using the ligation technique.…”