The Assessment of the Influence of the Method for Obtaining Hemostasis on the Occurrence of Postoperative Complications after Thyroid Surgery

Abstract

Background. The need to obtain successful surgical hemostasis had a significant impact on the development of electrosurgery. Innovative technical solutions necessitate the continuous training of surgeons in the use of more modern technologies. The diversity of solutions is also associated with the need to adapt the methods for obtaining hemostasis to the type of operation. Each time, the introduction of new technologies requires a critical evaluation of the results of surgical treatment. The most important measure of quality in thyroid surgery is the presence of chronic complications, such as the recurrent laryngeal nerve palsy and parathyroid insufficiency. Transient disorders also have a significant impact on the patient's comfort and quality of life. The report is preliminary in nature and it requires further investigation. Objectives. The aim of the study was to evaluate the effect of three methods for obtaining hemostasis on the occurrence of hypoparathyroidism, recurrent laryngeal nerve palsy, bleeding and the surgical site infection after thyroid surgery. Material and Methods. A retrospective analysis included patients who underwent thyroidectomy (n = 654). Three methods of hemostasis were used. The first group (n = 339) had blood vessels tied off. In the second (n = 192) bipolar electrocoagulation was used and in the third one (n = 123) bipolar electrocoagulation with integrated cutting mechanism. Results. The transient hypoparathyroidism was found in 1.4% patients in the first group, 8.3% in the second and 27.6% in the third one. Chronic hypoparathyroidism was found in 0.29% in the first group, 0% in the second group and 2.4% in the third group. Significantly statistical differences were found in the incidence of transient hypoparathyroidism.Conclusions. Significant statistical differences were found in incidences of transient hypoparthyroidism in the group where bipolar electrosurgery was used (Adv Clin Exp Med 2015, 24, 2, 275-278).

Haemostasis in Thyroid Surgery: Collagen-Fibrinogen-Thrombin Patch versus Cellulose Gauze—Our Experience

“…The use of instruments as the harmonic scalpel and radiofrequency or thermal devices also improves vessel sealing and several studies confirm their effectiveness to prevent hemorrhagic events [ 7 – 9 ].…”

Modified thyroidectomy: 4 techniques to prevent recurrent laryngeal nerve injury and postoperative hypocalcaemia

“…Praženica et al [38] reported permanent hypocalcemia in 1.5% of their cases. The traditional method for obtaining hemostasis is tying off and ligation of the cut vessels, ultrasonic vibration and bipolar electrocoagulation [39] . Grajek et al [39] reported in their study that the incidence of permanent RLN palsy and hypocalcemia were 0.8% and 2.4% in those who underwent bipolar electrocoagulation.…”

“…The traditional method for obtaining hemostasis is tying off and ligation of the cut vessels, ultrasonic vibration and bipolar electrocoagulation [39] . Grajek et al [39] reported in their study that the incidence of permanent RLN palsy and hypocalcemia were 0.8% and 2.4% in those who underwent bipolar electrocoagulation. However, the 4 techniques described in the current study reported the lowest incidence of permanent RLN palsy (0.16%) and hypocalcemia (0.3%).…”

Safety and efficacy of bipolar radiofrequency ablation device in hemostasis during thyroidectomy in comparison with ultrasonic scalpel: A comparative study

“…They suggested that the bipolar electrosurgical cautery is associated with less thermal effect leading to a significant reduction in the incidence of recurrent laryngeal nerve injury and postoperative hypoparathyroidism. [29]…”