Parathyroid function following total thyroidectomy using energy devices

Abstract

LigaSure precise (LP) and harmonic scalpel (HS) are two energy-based devices used in thyroidectomy surgery. We aimed to compare the effect of these two devices in patients who had undergone total thyroidectomy, by highlighting the post-operative parathyroid function. A total of 201 consecutive patients for whom total thyroidectomy had been planned were prospectively classified into two groups. There were 104 patients in LP group and 97 patients in HS group. Hypoparathyroidism was followed up by serially measuring the levels of intact parathyroid hormone (iPTH) and serum calcium. The early iPTH level was 29 (8-50) pg/mL in group LP, and 17 (4-43) pg/mL in group HS. The early iPTH level was significantly lower in the HS group (p < 0.001). However, these levels were within the reference interval in both groups. The early iPTH level was lower than 20 pg/mL in 23 (23.1 %) patients in HS group, and 15 (13.7 %) patients in LP group (p < 0.001). Also, the late iPTH levels were not statistically significance between two groups. The early and late serum calcium levels were not statistically significant between groups. However, the amount of calcium replacement was higher in the HS group than the LP group and the duration of treatment was longer in the HS group than the LP group (p < 0.05). In conclusion, although parathyroid hormone levels impaired in the HS group more than LP group in the early period, these levels were in the normal limits in both groups. These levels were not significant between groups in the long time period.

Comparing Hematoma Incidence between Hemostatic Devices in Total Thyroidectomy: A Systematic Review and Meta‐analysis

“…A summary of study characteristics and collected baseline patient variables can be found in Tables 1 and 2 , respectively. 6,8,9,14-33…”

Better consenting for thyroidectomy: who has an increased risk of postoperative hypocalcaemia?

“…Larger vessels would have been tied in most cases; however, more recently devices including Harmonic Scalpel (Ethicon) and LigaSure (Covidien) would have been used in some instances. Some papers have suggested the use of these devices may have an effect on parathyroid function, although no conclusive papers were found to date [18]. Intraoperative factors that have been shown in some series to be associated with increased risk of hypocalcaemia include: number of parathyroids identifies; parathyroids removed; autotransplantation of parathyroid tissue; and longer operative time [4,8,12,14].…”

Parathyroid hormone level after total thyroidectomy using conventional versus harmonic focus technique: Prospective randomized study

“…Due to variations in the parameters used to diagnose hypoparathyroidism, the incidence of hypoparathyroidism after thyroidectomy is variable, it was 5% in a study by Ref. [ 8 ], 1.6–83% [ 9 ], and 1.2–40% [ 10 ].…”

“…Hypoparathyroidism may be due to accidental parathyroid gland removal or vascular injury [ 9 ] Laboratory assessment of parathyroid function includes PTH and serum ca level [ 9 ].…”