title: Lateral spread of heat during thyroidectomy using different haemostatic devices.
abstract: BACKGROUND
  The presented study is an attempt to comprehensively analyze the lateral spread of heat during thyroidectomy. Obtained results may be valuable in other surgical disciplines in which thermal analysis is difficult or impossible.
  
  
  OBJECTIVE
  The aim of the study was to evaluate the temperature distribution in the operating field during thyroidectomy performed with the use of modern haemostatic instruments, and to define the safety margin for the investigated devices.
  
  
  METHODS
  Ninety-three patients were thyroidectomised due to thyroid neoplasm. During all the operations the thermovisual measurements were carried out along with continuous intraoperative neuromonitoring of the recurrent laryngeal nerve (CIONM). Investigated patients were divided into 5 groups, named according to the applied haemostatic technique: LigaSure (N=17); ThermoStapler (N=20); Focus (N=19); SonoSurg (N=17) and Monopolar (N=20).
  
  
  RESULTS
  At maximal performance settings, the highest working temperature was observed for the ThermoStapler, while the lowest temperature was recorded for the Monopolar. Safety margin and working time were increased in Focus and SonoSurg, compared to LigaSure and ThermoStapler. The differences in the necrosis thickness were negligible. The largest distance of the midline of the active blade from isotherm of 42ºC observed in the study was 5.51 mm; none of investigated devices used at a bigger distance had influence on the morphology of the electric signal of CIONM.
  
  
  CONCLUSIONS
  The thermo-visual camera allows non-invasive, safe, and real-time monitoring and analysis of temperature distribution in the operation area during thyroidectomy. Proposed minimal safety margin for the analysed devices is 5.51 mm.
authors.affiliation: 1. Department of Endocrinology and Metabolic Diseases, Medical University, Łódź, Poland 2. Department of Endocrinology and Metabolic Diseases, Polish Mother's Memorial Hospital/Research Institute, Łódź, Poland.
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Adamczewski
authors.affiliation: Department of Endocrinology and Metabolic Diseases, Polish Mother's Memorial Hospital/Research Institute, Łódź, Poland.
authors.forename: Aleksander
authors.initials: A
authors.lastname: Król
authors.affiliation: Laser Diagnostics and Therapy Centre, Technical University, Łódź, Poland.
authors.forename: Karolina
authors.initials: K
authors.lastname: Kałużna-Markowska
authors.affiliation: Department of Endocrinology and Metabolic Diseases, Polish Mother's Memorial Hospital/Research Institute, Łódź, Poland.
authors.forename: Jan
authors.initials: J
authors.lastname: Brzeziński
authors.affiliation: 1. Department of Endocrinology and Metabolic Diseases, Medical University, Łódź, Poland 2. Department of Endocrinology and Metabolic Diseases, Polish Mother's Memorial Hospital/Research Institute, Łódź, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Lewiński
authors.affiliation: Department of Oncological Endocrinology and Nuclear Medicine, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland.
authors.forename: Marek
authors.initials: M
authors.lastname: Dedecjus
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006489:Hemostatic Techniques / Q000295:instrumentation*; D006358:Hot Temperature; D006801:Humans; D064795:Intraoperative Neurophysiological Monitoring; D008875:Middle Aged; D011044:Poland; D012009:Recurrent Laryngeal Nerve / Q000502:physiology*; D013817:Thermography; D013965:Thyroidectomy / Q000295:instrumentation*; D055815:Young Adult