Novel hemostatic devices in thyroid surgery: electrothermal bipolar vessel sealing system and harmonic scalpel.
Accurate and efficient hemostasis is one of the first priorities of the thyroid surgeon to prevent or minimize complications, including injury to the laryngeal nerves or parathyroid glands, perioperative hemorrhage and the potentially life-threatening hematoma. Means to prevent and control intra- or postoperative bleeding therefore remain a topic of utmost importance. Although thyroidectomy is one of the most common surgical procedures, the safest, most efficient and cost-effective way to achieve hemostasis is debated by endocrine surgeons and otorhinolaryngologists. In our opinion, there is no substitute for meticulous surgical technique and hemostasis, while experience in such operations is essential for the best outcome with the fewest complications. Ties, suture-ligations, monopolar/bipolar diathermy, clips, and hemostatic agents/sealants or tissue adhesives have been used. Over the last 10 years, innovative hemostatic devices, such as the electrothermal bipolar vessel sealing system and ultrasonically activated shears, have been developed and have been welcome adjuncts to the thyroid surgeon's armamentarium. In this review we aim to cover both novel and well-established traditional techniques of hemostasis in thyroid surgery, with specific focus on the bipolar vessel sealer and harmonic scalpel.
Department of Endocrine Surgery, 1st Department of Propaedeutic Surgery, Hippocration Hospital, Athens Medical School, University of Athens, Vas. Sofias 114 Avenue, Athens, Greece. amanouras@hippocratio.gr
Andreas
A
Manouras
Haridimos E
HE
Markogiannakis
Panagiotis B
PB
Kekis
Emmanuel E
EE
Lagoudianakis
Bill
B
Fleming
D016063:Blood Loss, Surgical / Q000517:prevention & control*; D003972:Diathermy / Q000295:instrumentation*; D004564:Electrocoagulation / Q000295:instrumentation*; D004867:Equipment Design; D006488:Hemostasis, Surgical / Q000295:instrumentation* / Q000379:methods; D006490:Hemostatics / Q000627:therapeutic use; D006801:Humans; D008026:Ligation; D011312:Pressure; D013525:Surgical Instruments; D013537:Sutures; D013961:Thyroid Gland / Q000601:surgery*; D013965:Thyroidectomy / Q000009:adverse effects; D014014:Tissue Adhesives / Q000627:therapeutic use; D016896:Treatment Outcome; D014464:Ultrasonic Therapy / Q000295:instrumentation
D006490:Hemostatics; D014014:Tissue Adhesives