title: Meta-analysis of thyroidectomy with ultrasonic dissector versus conventional clamp and tie.
abstract: BACKGROUND
  We conducted a systematic review to evaluate the role of Ultrasonic dissector (UAS) versus conventional clamp and tie in thyroidectomy.
  
  
  METHODS
  We searched for all published RCT in into electronic databases. To be included in the analysis, the studies had to compare thyroidectomy with UAS versus conventional vessel ligation and tight (conventional technique = CT). The following outcomes were used to compare the total thyroidectomy group with UAS versus CT group: operative duration, operative blood loss, overall drainage volume during the first 24 hours, transiet laryngeal nerve palsy, permanent laryngeal nerve palsy, transiet hypocalcaemia and permanent hypocalcaemia.
  
  
  RESULTS
  There are currently 7 RCT on this issue to compare thyroidectomy with UAS versus CT. From the analysis of these studies it was possible to confront 608 cases: 303 undergoing to thyroidectomy with UAS versus 305 that were treated with CT. Actually, it was shown a relevant advantage of cost-effectiveness in patients treated with UAS; there is a statistically significant reduction of the operative duration (weighted mean difference [WMD], -18.74 minutes; 95% confidence interval [CI], (-26.97 to -10.52 minutes) (P = 0.00001), intraoperative blood loss (WMD, -60.10 mL; 95% CI, -117.04 to 3.16 mL) (P = 0.04) and overall drainage volume (WMD, -35.30 mL; 95% CI, -49.24 to 21.36 mL) (P = 0.00001) in the patients underwent thyroidectomy with UAS. Although the analysis showed that the patients who were treated with USA presented more favourable results in incidence of post-operative complications (transient laryngeal nerve palsy: P = 0.11; permanent laryngeal nerve palsy: not estimable; transient hypocalcaemia: P = 0.24; permanent hypocalcaemia: P = 0.45), these data didn't present statistical relevance.
  
  
  CONCLUSIONS
  This meta-analysis shown a relevant advantage only in terms of cost-effectiveness in patients treated with UAS; it is subsequent to statistically significant reduction of operation duration, intraoperative blood loss and of overall drainage volume during the first 24 hours. Although the analysis showed that the patients who were treated with UAS presented more favourable results in incidence of post-operative complications (transiet laryngeal nerve palsy; transiet hypocalcaemia and permanent hypocalcaemia), these data didn't present statistical relevance.
authors.affiliation: General and Emergency Surgical Unit, Department of Surgical Sciences, Radiology and Dentistry, University of Perugia, Perugia, Italy. cirocchiroberto@yahoo.it
authors.forename: Roberto
authors.initials: R
authors.lastname: Cirocchi
authors.forename: Fabio
authors.initials: F
authors.lastname: D'Ajello
authors.forename: Stefano
authors.initials: S
authors.lastname: Trastulli
authors.forename: Alberto
authors.initials: A
authors.lastname: Santoro
authors.forename: Giorgio
authors.initials: G
authors.lastname: Di Rocco
authors.forename: Domenico
authors.initials: D
authors.lastname: Vendettuoli
authors.forename: Fabio
authors.initials: F
authors.lastname: Rondelli
authors.forename: Domenico
authors.initials: D
authors.lastname: Giannotti
authors.forename: Alessandro
authors.initials: A
authors.lastname: Sanguinetti
authors.forename: Liliana
authors.initials: L
authors.lastname: Minelli
authors.forename: Adriano
authors.initials: A
authors.lastname: Redler
authors.forename: Antonio
authors.initials: A
authors.lastname: Basoli
authors.forename: Nicola
authors.initials: N
authors.lastname: Avenia
mesh_terms: D006801:Humans; D013959:Thyroid Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D013965:Thyroidectomy / Q000295:instrumentation* / Q000379:methods*; D016896:Treatment Outcome; D014465:Ultrasonics; D014463:Ultrasonography