title: LigaSure® versus clamp tie technique for thyroid surgery; decreased operative time versus increased inflammatory effect: a prospective randomized study.
abstract: OBJECTIVE
  The aim of this study was to compare the LigaSure® Small Jaw Instrument (LSJI) with the conventional clamp-and-tie (CT) technique in thyroid surgery regarding complication rates (hematoma, hypocalcemia and recurrent nerve palsy), the duration of the operative procedure, and systemic and local inflammatory effects.
  
  
  METHODS
  Fifty-four consecutive patients were randomized prospectively into two groups, a Conventional Clamp-Tie (CT) group and a LigaSure® Vessel Sealing System (LVSS) Group. Pre- and postoperative blood plasma samples were taken to measure the tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6), calcium, parathormon, CRP levels and WBC, as well as the lymphocyte subset (CD3, CD4, CD8, CD16/56, CD19) counts. The drain fluid samples were collected after the removal of the drains to measure the levels of IL-6 and TNF-α.
  
  
  RESULTS
  Both groups showed significant changes regarding peripheral blood CD3+, CD4+, and CD8+ T cell levels (p < 0.05). In the LVSS group, the level of CD16+56+ NK cells showed a significant decrease compared with the CT group (p < 0.05). The IL-6 and TNF-α levels in the drainage fluid were significantly higher in the LVSS group.
  
  
  CONCLUSIONS
  We demonstrated that LSJI can decrease operative time. Although the systemic inflammatory effect of LSJI remains inconclusive, the local inflammatory effect was significant, which could cause early and late postoperative problems.
authors.affiliation: Department of Surgery, Baskent University, Faculty of Medicine, Istanbul Research Hospital, Istanbul, Turkey. ozgurkemik @hotmail.com.
authors.forename: H Y
authors.initials: HY
authors.lastname: Bircan
authors.forename: A
authors.initials: A
authors.lastname: Inal
authors.forename: U
authors.initials: U
authors.lastname: Ozcelik
authors.forename: B
authors.initials: B
authors.lastname: Koc
authors.forename: A
authors.initials: A
authors.lastname: Demirag
authors.forename: G
authors.initials: G
authors.lastname: Moray
authors.forename: O
authors.initials: O
authors.lastname: Kemik
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006406:Hematoma; D006801:Humans; D007249:Inflammation / Q000097:blood* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011446:Prospective Studies; D013525:Surgical Instruments; D013961:Thyroid Gland / Q000601:surgery*; D013965:Thyroidectomy / Q000295:instrumentation* / Q000379:methods