Does using an energized device in open thyroidectomy reduce complications?

• Published in: The Journal of surgical research 2013-05, Vol.181 (1), p.e23-e29
• Main Authors: Lang, Brian Hung-Hin, MS, FRACS, Yih, Patricia Chun-Ling, MBBS, MRCS, Hung, Grace Kin-Yee, MBBS, MRCS
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Child; Electrocautery; Female; Humans; Male; Middle Aged; Operative Time; Postoperative Complications - prevention & control; Postoperative hypoparathyroidism; Recurrent laryngeal nerve injury; Surgery; Surgical outcome; Thyroidectomy; Thyroidectomy - adverse effects; Thyroidectomy - instrumentation; Ultrasonic therapy
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2012.06.012

Abstract Background Although using energy devices during open thyroidectomy might shorten the procedure time compared with the conventional technique, its effect on procedure-related complications remains unclear and controversial. In an era of cost containment, we aimed to compare the rate of procedure-related complications (particularly vocal cord palsy and hypoparathyroidism) between patients who underwent thyroidectomy using reusable ultrasonic shears and those who did not. Methods Of 508 eligible patients, 237 (46.7%) underwent thyroidectomy using the SonoSurg (reusable ultrasonic shears; SonoSurg group) and 271 (53.3%) underwent thyroidectomy using the conventional technique (suture ligation and clips; conventional technique group). The reusable shears were autoclaved at the end of each procedure and replaced after every 20 cases. To evaluate the effect of the ultrasonic shears on procedure-related complications, the patient characteristics and outcomes were compared between the 2 groups. Results In the SonoSurg group, the total operating time (60 min versus 105 min, P < 0.001) and temporary (12.4% versus 25.5%, P = 0.009) and permanent hypoparathyroidism (1.9%  versus 9.8%, P = 0.003) rates were significantly less than those in the conventional technique group. The permanent vocal cord palsy rate was similar ( P = 0.262). On multivariate analysis, using the reusable shears (odds ratio 0.163; 95% confidence interval 0.047–0.570; P  = 0.005) and parathyroid autotransplantation of at least 1 gland (odds ratio 0.370; 95% confidence interval 0.146–0.943; P = 0.037) were the 2 independent variables for permanent hypoparathyroidism after completion/total thyroidectomy. Conclusions Using the reusable shears during open thyroidectomy was significantly associated with a shortened operating time and lower permanent hypoparathyroidism rate, although the vocal cord palsy rate remained similar.