LIGASURE EM TIREOIDECTOMIA TOTAL
Saint M, Cogliandolo A, Piquard A, Fama F, Pidoto R. LigaSure vs clamp-and-tie technique to achieve hemostasis in total thyroidectomy for
benign multinodular goiter: a prospective randomized study. Archives of Surgery 2007;142:150-156.
Abstract: HYPOTHESIS: Occurrence of adverse effects
and advantages of the Liga Sure diathermy system (or LigaSure vessel sealing system)
in total thyroidectomy have not been tested in prospective randomized studies comparing its
use with that of the time-saving clamp-and-tie technique to ligate and divide thyroid
vessels. The effectiveness of LigaSure in achieving vessel division and hemostasis remains
dependent on vessel diameter, and the risk of damage to adjacent structures cannot be
completely excluded. We tested the
hypothesis that use of LigaSure compared with the
clamp-and-tie technique can significantly and conveniently reduce operative time without
increasing postoperative complications in patients undergoing total thyroidectomy for benign
multinodular goiter.
DESIGN:Prospective randomized study.
SETTING: Regional
hospital.
PATIENTS: Two hundred consecutive patients with benign multinodular goiter
undergoing total thyroidectomy
performed by 1 of 3 surgeons.
INTERVENTIONS: According
to a randomized sequence,
total thyroidectomy was performed in 100 patients
using LigaSure and in 100 patients using
the clamp-and-tie technique.
MAIN OUTCOME MEASURES:
End points of the study included the comparative evaluation of postoperative
complications, need for parathyroid gland autotransplantation, operative time, and time to
hospital discharge. Preoperative, postoperative (24 hours), and 6-week follow-up serum
Ca (++) levels are also reported and
compared.
RESULTS: The postoperative complication rate
was 35% overall, including all transient postoperative disturbances. The incidence of
cervical hematomas was 2%, but 3 patients (1.5%), 1 in the LigaSure group and 2 in the
clamp- and-tie group, required repeat operations because of respiratory tract obstruction.
The incidence of permanent complications was 2.5% overall, including 3 patients
(1.5%) with permanent hypocalcemia and 2 patients (1%) with permanent recurrent nerve
lesions. No statistical difference in the
incidence of complications was found between the 2
study groups. Similarly, no difference was found in mean hospitalization time and need for
parathyroid gland autotransplantation. Preoperative, postoperative, and 6-week follow-up mean
serum Ca(++) levels were not statistically different in the 2 study groups and in
the subset of patients undergoing parathyroid gland autotransplantation. Mean operative
time was significantly shorter in the LigaSure group, although the mean difference between
the 2 study groups was minimal (7.4
minutes). Concomitantly, there was an additional cost
of 45euro (US $57.40) per operation
using LigaSure.
CONCLUSION: The use of LigaSure is equally as
safe and effective at
vessel division
and homeostasis as the clamp-and-tie technique, with a statistically
significant
(although minimal) decrease in mean operative time. Because of this minimal
decrease in
operative time, use of LigaSure would allow more patients to undergo total
thyroidectomy each year, which would eventually help to offset its
higher cost
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