title: Total thyroidectomy with ultrasonic dissector for cancer: multicentric experience.
abstract: BACKGROUND
  We conducted an observational multicentric clinical study on a cohort of patients undergoing thyroidectomy for thyroid carcinoma. The aim of this study was to evaluate the benefits of the use of ultrasonic dissector (UAS) vs. the use of a conventional technique (vessel clamp and tie) in patients undergoing thyroid surgery for cancer.
  
  
  METHODS
  From June 2009 to May 2010 we evaluated 321 consecutive patients electively admitted to undergo total thyroidectomy for thyroid carcinoma. The first 201 patients (89 males, 112 females) presenting to our Department underwent thyroidectomy with the use of UAS while the following 120 patients (54 males, 66 females) underwent thyroidectomy performed with a conventional technique (CT): vessel clamp and tie.
  
  
  RESULTS
  The operative time (mean: 75 min in UAS vs. 113 min in CT, range: 54 to 120 min in UAS vs. 68 to 173 min in CT) was much shorter in the group of thyroidectomies performed with UAS. The incidence of transient laryngeal nerve palsy (UAS 3/201 patients (1.49%); CT 1/120 patients (0.83%)) was higher in the group of UAS; the incidence of permanent laryngeal nerve palsy was similar in the two groups (UAS 2/201 patients (0.99%) vs. CT 2/120 patients (1.66%)). The incidence of transient hypocalcaemia (UAS 17/201 patients (8.4%) vs. CT 9/120 patients (7.5%)) was higher in the UAS group; no relevant differences were reported in the incidence of permanent hypocalcaemia in the two groups (UAS 5/201 patients (2.48%) vs. 2/120 patients (1.66%)). Also the average postoperative length of stay was similar in two groups (2 days).
  
  
  CONCLUSIONS
  The only significant advantage proved by this study is represented by the cost-effectiveness (reduction of the usage of operating room) for patients treated with UAS, secondary to the significant reduction of the operative time. The analysis failed to show any advantages in terms of postoperative transient complications in the group of patients treated with ultrasonic dissector: transient laryngeal nerve palsy (1.49% in UAS vs. 0.83% in CT) and transient hypocalcaemia (8.4% in UAS vs. 7.5%in CT). No significant differences in the incidence of permanent laryngeal nerve palsy (0.8% in UAS vs. 1.04% in CT) and permanent hypocalcaemia (2.6% in UAS vs. 2.04% in CT) were demonstrated. The level of surgeons' expertise is a central factor, which can influence the complications rate; the use of UAS can only help surgical action but cannot replace the experience of the operator.
authors.affiliation: Department of General Surgery, S, Maria Hospital, University of Perugia, Terni, Italy. cirocchiroberto@yahoo.it
authors.forename: Roberto
authors.initials: R
authors.lastname: Cirocchi
authors.forename: Carlo
authors.initials: C
authors.lastname: Boselli
authors.forename: Salvatore
authors.initials: S
authors.lastname: Guarino
authors.forename: Alessandro
authors.initials: A
authors.lastname: Sanguinetti
authors.forename: Stefano
authors.initials: S
authors.lastname: Trastulli
authors.forename: Jacopo
authors.initials: J
authors.lastname: Desiderio
authors.forename: Alberto
authors.initials: A
authors.lastname: Santoro
authors.forename: Fabio
authors.initials: F
authors.lastname: Rondelli
authors.forename: Giovanni
authors.initials: G
authors.lastname: Conzo
authors.forename: Domenico
authors.initials: D
authors.lastname: Parmeggiani
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Noya
authors.forename: Giorgio
authors.initials: G
authors.lastname: De Toma
authors.forename: Nicola
authors.initials: N
authors.lastname: Avenia
mesh_terms: D018263:Adenocarcinoma, Follicular / Q000473:pathology / Q000601:surgery*; D002291:Carcinoma, Papillary / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006996:Hypocalcemia / Q000175:diagnosis / Q000209:etiology; D008297:Male; D009367:Neoplasm Staging; D061646:Operative Time; D011183:Postoperative Complications; D011379:Prognosis; D013964:Thyroid Neoplasms / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy; D013997:Time Factors; D059708:Ultrasonic Surgical Procedures / Q000295:instrumentation* / Q000379:methods