title: Thermal sealing systems with and without tissue divider for total thyroidectomy.
abstract: BACKGROUND
  Sutureless thyroid surgery utilizing thermal sealing is now well established. However, incremental advances in technology still require formal clinical evaluation in order to ensure that added technology does not compromise safety. In this study, we compared a new thermal sealing device incorporating a tissue divider (LigaSure Small Jaw) with the device we have previously reported for use in total thyroidectomy (LigaSure Precise).
  
  
  METHODS
  A cohort study was undertaken of 872 total thyroidectomies over a 2-year period. Patients were selected for each group on the basis of device availability within four institutions and outcomes were obtained from a prospectively maintained database.
  
  
  RESULTS
  Small Jaw was used in 399 cases and Precise in 473. No significant differences between patient demographics (sex, age), operation indication or pathology were found. Significantly more Small Jaw operations were performed in private versus public hospitals (P < 0.01). Regarding outcomes, there was no significant difference in the incidence of any complication (haematoma, temporary/permanent hypoparathyroidism or temporary/permanent recurrent laryngeal nerve injury). In a subgroup analysis of operations performed in the public hospital system, Small Jaw was found to be significantly faster (mean operative time: 79 versus 103 min) (95% CI 74-84 and 96-110 min) (P < 0.01).
  
  
  CONCLUSIONS
  The incorporation of a tissue divider into thermal sealing devices is efficacious and safe, with no compromise in clinical outcome, while providing the added benefit of a significant reduction in operative times.
authors.affiliation: Kolling Institute of Medical Research, Cancer Genetics Laboratory, Royal North Shore Hospital and The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Anthony R
authors.initials: AR
authors.lastname: Glover
authors.forename: Justin S
authors.initials: JS
authors.lastname: Gundara
authors.forename: James C
authors.initials: JC
authors.lastname: Lee
authors.forename: Mark S
authors.initials: MS
authors.lastname: Sywak
authors.forename: Leigh W
authors.initials: LW
authors.lastname: Delbridge
authors.forename: Stan B
authors.initials: SB
authors.lastname: Sidhu
mesh_terms: D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D013965:Thyroidectomy / Q000295:instrumentation* / Q000379:methods; D016896:Treatment Outcome
keywords: complications; haemostasis; parathyroid glands; recurrent laryngeal nerve; surgery