Comparison of LigaSure vessel sealing system, harmonic scalpel, and conventional hemostasis in total thyroidectomy.
OBJECTIVE
The aim of the study was to compare the efficiency, safety, and cost of the different methods of hemostasis (conventional hemostasis versus LigaSure vessel sealing system [LVSS] versus harmonic scalpel) currently available for thyroid surgery.


METHODS
Randomized, controlled trial.


METHODS
The study was conducted from September 2007 to December 2008 in a university hospital.


METHODS
Sixty patients (48 females and 12 males) underwent a total thyroidectomy for multinodular goiter. They were randomly assigned into three groups: group one (n = 20), conventional hemostasis; group two (n = 20), LigaSure; and group three (n = 20), harmonic scalpel.


RESULTS
For group three, the mean operative time was 37 minutes shorter than group one (P < 0.001) and eight minutes shorter than group two (P = 0.04). The complications rate was similar among the three groups. The mean postoperative paracetamol consummation in group one was 1.4 g greater than in group two (P = 0.016) and 1.3 g greater than in group three (P = 0.02). The overall average operative cost was 11 and 85 dollars cheaper for groups two and three than for group one, respectively (P < 0.001).


CONCLUSIONS
Total thyroidectomy using the harmonic scalpel was the fastest procedure because it was bloodless, and hemostasis and sectioning were controlled with a single instrument; it was, therefore, the most inexpensive procedure because of the reduction of operative time and staff cost. The operative safety was similar for all three procedures. In our series, the harmonic scalpel and the LVSS caused less pain than the conventional hemostasis.
Department of Head and Neck Surgery, Hôpital du Val de Grâce, Paris, France. pons.yoann@gmail.com
Yoann
Y
Pons
Jérome
J
Gauthier
Elsa
E
Ukkola-Pons
Philippe
P
Clément
Eric
E
Roguet
Jean-Luc
JL
Poncet
Claude
C
Conessa
D016063:Blood Loss, Surgical; D003365:Costs and Cost Analysis; D004322:Drainage; D004564:Electrocoagulation; D005260:Female; D006488:Hemostasis, Surgical / Q000191:economics / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D013525:Surgical Instruments; D013965:Thyroidectomy; D014465:Ultrasonics