LigaSure versus clamp-and-tie in thyroidectomy: a single-center experience

Abstract

Purpose: LigaSure (ValleyLab, CO, USA) is a bipolar diathermy system that seals vessels with reduced thermal spread. The device has been used successfully in abdominal surgery and has been introduced as a new method for hemostasis during thyroidectomy. This study compares the efficacy and advantages of LigaSure, when used for thyroidectomy in benign nodular thyroid disease, with the conventional clamp-and-tie technique. Methods: Between December 2003 and December 2008, 410 patients underwent thyroid surgery (333 with the conventional clamp-and-tie technique and 77 with LigaSure). Nine patients did not sign the ethical approval document and so were excluded from the study; the results of 68 LigaSure patients were evaluated. The main outcomes measured were age, sex, operating time, postoperative hypocalcemia, recurrent laryngeal nerve palsy, and drain use. 0078-6 11 Statistical analysis consisted of the chi-squared test and Student's t-test. Results: The mean operating time was significantly shorter in the LigaSure group by 24.1±1.7 minutes for a total thyroidectomy (P<0.0001) and 7.6±0.1 minutes for one side total plus other side subtotal thyroidectomy (P<0.0001). Bleeding during surgery was significantly lower in the LigaSure group (P<0.0001). There were no significant differences between the study groups in terms of postoperative hypoparathyroidism, recurrent laryngeal nerve palsy, and postthyroidectomy hemorrhage. Conclusion: TheLigaSure vessel sealer is a safe, effective alternative for thyroid surgery that reduces the overall operating time. However, its higher cost is a significant handicap for its use in surgery in developing countries.

Use of Ligasure Sealing Versus Conventional Suture - Ligation in Total Thyroidectomy

“…When it was soaked by 50 % the means that it contains about 25 ml of blood and if totally soaked; 100% this means that it contains 75 ml of blood [16]. Many researchers reported significant reduction of intra-operative blood loss by the use of ligasure system in total thyroidectomy when compared with the conventional sutureligation technique [6,17,18,19] and our data came in agreement with those reported results. The ligasure vessel sealing system can apply control, sealing vessels up to 7 mm in diameter and facilitates surgery by achieving the efficient haemostasis of blood vessels encountered during dissection, and allowing the rapid and secure division of vascularised tissues, while minimizing thermal injury to adjacent tissues [20].…”

“…Regarding the operative time, our data came in concordance with those reported in previous studied and the authors of these studies found significant difference in operative time reduction in case of ligasure [6,11,12,13]. The conventional suture knot tying technique requires a large number of surgical ties and this maneuver is time consuming and requires good exposure [7] Estimation of intra-operative blood loss is governed by visual method [14] and the clinical assessment with collaboration with the anesthetist [15].…”

“…Other signs of infection, such as fever and leukocytosis, without an overlying cellulitis, may point to a deep space neck infection or abscess [32]. Postoperative wound infection was observed a bit higher following total thyroidectomy than lobectomy due to more tissue trauma [33] and the surgical site infection rate was detected in the conventional suture knot tying technique group and there was no infection sign in the ligasure group in another study [6]. The accepted explanation of this reduction rate is that the conventional suture knot tying technique requires a large number of surgical ties and is time consuming ,decreases healing as well as increases wound infection, requires good exposure, injury to neighboring structures and foreign body reaction [7] …”

“…Thyroid surgery involves meticulous devascularization of the thyroid gland, which has one of the richest blood supplies of all organs, with numerous blood vessels and plexuses entering its parenchyma. Therefore, hemostasis is of paramount importance when dividing the various vessels before excising the gland [6]. Effective vessel haemostasis can be achieved by suture knot tying technique or newer techniques of vessel haemostasis like ligasure as an alternative bipolar surgical diathermy system [7].…”

Comparison of an Intraoperative Application of a Haemostatic Agent (PerClot&lt;sup&gt;&amp;reg&lt;/sup&gt;) with Conventional Haemostatic Procedure after Thyroid Resection

“…There are several standard techniques for mastery of bleeding complications like suture ligation of individual vessels and electrocoagulation [7]. In addition to these standard techniques, the new haemostatic devices like Ligasure ® [19] and Harmonic Scalpel [20] (e.g.) which have proven to decrease the risk for postoperative bleeding and intra-operative blood loss [21], could be useful in the surgical management of postoperative bleeding.…”