Ultrasonic Scalpel Versus Classic Procedures with Limited Access in Thyroid Gland Surgery

Abstract

The aim of the study was to demonstrate the advantages of employing the ultrasonic scalpel in maintaining appropriate intraoperative hemostasis as compared with traditional methods of thyroid vessel ligation and coagulation Material and methods. Between December 2003 and May 2006, 2410 patients were managed for various thyroid diseases at the Department of Endocrine Surgery. In the presented group, 179 procedures that employed minimally invasive surgical techniques including 101 operations in which US was used to secure the thyroid vessels (group A) and 78 operations in which the superior thyroid vessels were clipped and subjected to bipolar coagulation without US (group B) were performed. Both groups were similar with respect to gender, age, indications for surgery and mean thyroid volume. Statistical analysis included mean operative time, postoperative blood loss, scar length and cosmetic satisfaction assessed on visual-analogue scale (VAS) at 1 month following surgery. Results. Mean operative time was significantly greater in group B vs A (54.5(plus or minus)14.2 vs 35.4(plus or minus)8.7 min, respectively; t-test; p<0.001). Mean postoperative blood loss was significantly higher in group B vs A (32.8(plus or minus)13.0 vs 12.9(plus or minus)5.7 ml, respectively; t-test; p<0.001). One case of transient paralysis of the recurrent laryngeal nerve and two instances of postoperative drop in calcium concentration values below the normal range was observed. The mean scar length at 1 month following surgery was significantly longer in group B vs A (21.5(plus or minus)1.9 vs 15.6(plus or minus)1.4 mm, respectively; t-test; p<0.001). Cosmetic satisfaction was significantly lower in group B vs. A patients (81.9(plus or minus)5.4 vs 88.9(plus or minus)9.7pts, respectively; t-test; p<0.001). Conclusion. The use of an ultrasonic scalpel in thyroid surgery reduces the mean operative time, achieves good hemostasis and improves cosmetic results without increasing the risk of morbidity.