title: A comparison of the outcome using Ligasure™ small jaw and clamp-and-tie technique in thyroidectomy: a randomized single center study.
abstract: OBJECTIVE
  Hypoparathyroidism and paralysis of the recurrent laryngeal nerve (RLN) still remain the most frequent specific complications of thyroid surgery. This study evaluates the effects of employment of a recently introduced device (LigaSure™ Small Jaw, LSJ), compared to the traditional clamp-and-tie (CT) technique, on the short- and long-term outcome of the patients who underwent thyroidectomy.
  
  
  METHODS
  This prospective, randomized study included 190 patients enrolled from October 2011 to July 2013. The numbers of patients in the LSJ group and the CT group were both 95. We studied the following: operative times, intraoperative and postoperative blood losses, intact parathormone (iPTH) and calcium serum levels, and the incidence of RLN paralysis.
  
  
  RESULTS
  The two cohorts were homogeneous for age, sex, surgical indication, BMI, ASA score, and estimated thyroid volume. Operation time has been 73.90 ± 23.35 min in group CT and 60.20 ± 22.36 min in group LSJ (p = 0.002). Intraoperative blood losses have been 47 ± 18 ml in group CT and 38 ± 14 in group LSJ (p = 0.002), while postoperative blood losses have been 45 ± 21 ml in group CT and 40 ± 20 in group LSJ (p = 0.105). The mean calcium blood level in group CT has been 8.12, 7.79, and 7.92 mg/dl in the first, second, and third postoperative days, respectively, as well as 8.26, 7.97, and 8.22 mg/dl for group LSJ (p > 0.05). Basal and post-thyroidectomy iPTH levels have been 46.49 and 23.64 pg/ml in group CT (Δ = 49.15 %), as well as 51.06 and 27.73 (Δ = 45.69 %) in group LSJ (p > 0.05). Permanent RLN paralysis was 1.05 % in LSJ group and 0 % in CT group.
  
  
  CONCLUSIONS
  The employment of LSJ reduces in a statistically significant way both operative times and intraoperative blood losses. No significant differences were found as far as postoperative RLN paralysis and hypoparathyroidism.
authors.affiliation: Department of Surgical Specialties and Organ Transplantation "P. Stefanini", Policlinico Umberto I-Sapienza-University of Rome, Rome, Italy, s.coiro@libero.it.
authors.forename: S
authors.initials: S
authors.lastname: Coiro
authors.forename: F M
authors.initials: FM
authors.lastname: Frattaroli
authors.forename: F
authors.initials: F
authors.lastname: De Lucia
authors.forename: E
authors.initials: E
authors.lastname: Manna
authors.forename: F
authors.initials: F
authors.lastname: Fabi
authors.forename: J M
authors.initials: JM
authors.lastname: Frattaroli
authors.forename: G
authors.initials: G
authors.lastname: Pappalardo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006488:Hemostasis, Surgical / Q000295:instrumentation*; D006801:Humans; D006980:Hyperthyroidism / Q000175:diagnosis / Q000601:surgery*; D007011:Hypoparathyroidism / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D063868:Patient Outcome Assessment; D011183:Postoperative Complications / Q000517:prevention & control; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000503:physiopathology; D011446:Prospective Studies; D020127:Recovery of Function; D061226:Recurrent Laryngeal Nerve Injuries / Q000517:prevention & control*; D018570:Risk Assessment; D013525:Surgical Instruments; D013965:Thyroidectomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome