title: Risk of Complications with Energy-Based Surgical Devices   in Thyroid Surgery: A National Multicenter Register Study.
abstract: BACKGROUND
  Energy-based surgical devices (EBD) combining cutting and coagulation are increasingly used in thyroid surgery. However, there is a lack of information about potential benefits and risk of complications outside controlled trials. The aims of this national multicenter register study were to describe the use of EDB, their potential effect on complication rates, and on operation time.
  
  
  METHODS
  The Scandinavian Quality Register for Thyroid and Parathyroid surgery includes 35 surgical units in Sweden and covered 88% of the thyroid procedures performed during 2008–2009. The use of the EBD was specifically registered for 12 months, and 1297 patients were included. Surgically related complications and operation time were evaluated. The clamp-and-tie group (C-A-T) constituted the control group for comparison with procedures where EBD was used.
  
  
  RESULTS
  The thyroid procedures performed included C-A-T (16.6%), bipolar electrosurgery (ES: 56.5%), electronic vessel sealing (EVS: 12.2%), and ultrasonic dissection (UD: 14.5%). Mean operative time was longer with EVS (p < 0.001) and shorter with UD (p < 0.05) than in the other groups. The bipolar ES group and the EVS group had higher incidence of calcium treatment at discharge and after 6 weeks than the UD group. No significant difference in nerve injury was found between the groups. There was a significant more frequent use of topical hemostatic agents in the EBD group compared to C-A-T.
  
  
  CONCLUSIONS
  In this national multicenter study, the use of UD shortened and EVS increased operating time. There was a higher risk of calcium treatment at discharge and after 6 weeks after use of EVS and bipolar ES than after UD use. There was a significant more frequent use of topical hemostatic agents in the EBD groups compared to C-A-T.
authors.forename: Johan
authors.initials: J
authors.lastname: Carlander
authors.forename: Philippe
authors.initials: P
authors.lastname: Wagner
authors.forename: Oliver
authors.initials: O
authors.lastname: Gimm
authors.forename: Erik
authors.initials: E
authors.lastname: Nordenström
authors.forename: Svante
authors.initials: S
authors.lastname: Jansson
authors.forename: Leif
authors.initials: L
authors.lastname: Bergkvist
authors.forename: Kenth
authors.initials: K
authors.lastname: Johansson
mesh_terms: D004598:Electrosurgery / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology*; D012042:Registries; D013548:Sweden / Q000453:epidemiology; D013959:Thyroid Diseases / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods*