title: Sutureless total thyroidectomy: a safe and cost-effective alternative.
abstract: BACKGROUND
  Advanced vessel sealing devices provide an alternative to conventional ligation techniques for thyroidectomy. To date, most studies have been inadequately powered to explore differences in the infrequent post-operative complications following thyroidectomy. This study is designed to compare the outcomes of sutureless thyroidectomy and conventional thyroidectomy for recurrent laryngeal nerve (RLN) injury, permanent hypoparathyroidism, and haematoma formation.
  
  
  METHODS
  A cohort study of consecutive patients undergoing total thyroidectomy using conventional versus sutureless techniques was performed. Sutureless thyroidectomy was performed using either Ligasure Precise (Covidien) or Harmonic Focus (Johnson and Johnson) devices. The primary outcome measures were post-operative haemorrhage, permanent RLN injury and hypoparathyroidism. Secondary outcome measures were operative time, temporary hypoparathyroidism and vocal cord dysfunction. A cost minimization analysis comparing the two techniques was performed.
  
  
  RESULTS
  From January 2006 to July 2009, 1935 consecutive patients underwent total thyroidectomy. Of these, 772 underwent conventional thyroidectomy and 1163 were performed using a sutureless technique. The mean operative time was significantly lower in the sutureless group (71 versus 86 min, P = 0.02). There was no difference in the post-operative complications of haematoma (0.78% conventional versus 1.12% sutureless, P = 0.46), permanent hypoparathyroidism (1.30% conventional versus 0.52% sutureless, P = 0.06) or permanent RLN injury (0.26% conventional versus 0.52% sutureless, P = 0.39). There was an overall cost saving of AUD$14,300 per 100 total thyroidectomy cases performed using the sutureless technique.
  
  
  CONCLUSIONS
  Sutureless thyroidectomy is a safe and efficient way of performing total thyroidectomy and has the potential to reduce operating room costs.
authors.affiliation: University of Sydney Endocrine Surgical Unit, NSW, Australia.
authors.forename: Ling-Yun
authors.initials: LY
authors.lastname: Chang
authors.forename: Christine
authors.initials: C
authors.lastname: O'Neill
authors.forename: James
authors.initials: J
authors.lastname: Suliburk
authors.forename: Stan
authors.initials: S
authors.lastname: Sidhu
authors.forename: Leigh
authors.initials: L
authors.lastname: Delbridge
authors.forename: Mark
authors.initials: M
authors.lastname: Sywak
mesh_terms: D016063:Blood Loss, Surgical / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D004564:Electrocoagulation / Q000191:economics / Q000295:instrumentation; D005260:Female; D006488:Hemostasis, Surgical / Q000191:economics / Q000295:instrumentation*; D006801:Humans; D007011:Hypoparathyroidism / Q000209:etiology; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000209:etiology; D061226:Recurrent Laryngeal Nerve Injuries / Q000209:etiology; D013965:Thyroidectomy / Q000009:adverse effects / Q000191:economics / Q000379:methods*