Bipolar thermofusion vessel sealing system (TVS) versus conventional vessel ligation (CVL) in thyroid surgery--results of a prospective study.
BACKGROUND
One of the keystones in surgery of the thyroid gland is accurate hemostasis. This can be achieved by conventional ligations or new instruments as harmonic scissors or bipolar devices. In the present study, we report our experience with a new bipolar thermofusion vessel sealing system (TVS) compared to conventional vessel ligation (CVL).


METHODS
This prospective non-randomized study included 186 patients operated on by two surgeons between April and November 2007. Age, gender, preoperative diagnosis, type of surgery, operative time, and complications were prospectively collected. TVS was used in 93 patients (29 M, 64 F; mean age 50+/-14 years, range 11-83) and CVL in 93 patients (27 M, 66 F; mean age 49+/-14 years, range 16-82). Results and postoperative complications were registered.


RESULTS
Postoperative complications included two cases of transient hypocalcaemia in both groups 1 (TVS group) and 2 (CVL group) hemorrhages requiring reoperation (p = ns). No recurrent laryngeal nerve palsy was observed in both groups. A drain was used in 25 cases in the TVS group and in 47 patients in the CVL group (p<0.008). Mean operative time for total thyroidectomy was significantly shorter in the TVS group (73+/-18 min, range=35-110) than in the CVL group (18+/-20 min, range = 40 -130; p<0.01). No differences were found for lobectomies or subtotal thyroidectomies.


CONCLUSIONS
TVS is safe with a similar complication rate as CVL. Mean operative time for total thyroidectomy is shortened with TVS.
Alesina
Pier Francesco
PF
Klinik für Chirurgie und Zentrum für Minimal Invasive Chirurgie, Kliniken Essen-Mitte, Akademisches Lehrkrankenhaus der Universität Duisburg-Essen, Henricistrasse 92, 45136 Essen, Germany. pieroalesina@libero.it
Rolfs
Thomas
T
Walz
Martin K
MK
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000517:prevention & control / Q000706:statistics & numerical data; D016009:Chi-Square Distribution; D002648:Child; D003362:Cost-Benefit Analysis; D005260:Female; D006488:Hemostasis, Surgical / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D006801:Humans; D006996:Hypocalcemia / Q000209:etiology; D008026:Ligation / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D019106:Postoperative Hemorrhage / Q000209:etiology; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D013965:Thyroidectomy / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D014464:Ultrasonic Therapy / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D020535:Video-Assisted Surgery