Early Experience with LigaSure Thyroidectomy in a Nigeria Teaching Hospital

Use of energy device in general surgical operations: impact on peri-operative outcomes

BACKGROUND

The introduction of energy devices has significantly expanded the scope of surgical expedition. The LigaSure™ vessel sealing system is a bipolar electrosurgical device, recently introduced to our practice. Its impact on peri-operative outcomes in a variety of major operations was evaluated in this study.

METHODS

A retrospective review of operations performed following the adoption of the LigaSure™ vessel sealing device was carried out. Five categories of operations were evaluated (Thyroidectomies, Gastrectomies, Colectomies, Pancreaticoduodenectomies, and Anterior/Abdomino-perineal resection [A/APR of the rectum). Peri-operative outcomes (duration of operation, intra-operative blood loss, blood transfusion rates) were compared with a cohort of similar operations performed using conventional techniques. Data analysis and comparisons were done on a subgroup basis.

RESULTS

A total of 117 operations were performed using the LigaSure™ device with thyroidectomies being the most common (66/117-56.4%). Compared to cases done using conventional techniques of suture and knot with electrocautery (120 cases), the use of LigaSure™ was associated with a significant reduction in operation time in all categories of operations. Intraoperative blood loss was also lower in all categories of cases, but this was only statistically significant following A/APR and Thyroidectomies. Generally, there was a trend towards a reduction in blood transfusion rates.

CONCLUSIONS

The use of energy devices for surgical operations is feasible in a resource-limited setting. It has the potential of improving outcomes.

Sutureless Total Thyroidectomy for Substernal Goiter: Amending Versus Unnecessary

Substernal goiter is an enlarged thyroid gland, harboring a component extending into the mediastinum. Surgical management requires genuine and rigorous preoperative planning as physicians could encounter the prospect of the gland coming into close quarters with the vital intrathoracic structures. The neck and chest multiplanar cross-sectional imaging provide essentialness of an extracervical approach for the procedure. In the present study, a 57-year-old female who admitted with the intermittent dyspnea and dysphagia with a huge goiter is reported. The labs were reported within the normal limits and the video laryngoscopy displayed no pathologic finding. Her neck sonography revealed the multiple nodules within the gland, without determining the most proximal border of the left lobe. The neck and chest computed tomography depicted a substernal goiter harboring the left lobe, extending till the left innominate vein and a sutureless total thyroidectomy by the collar incision without a median sternotomy was performed. We would recommend sutureless thyroidectomy for substernal goiter just considering to divide meticulously the superior thyroid arteries and veins separately and exploring the fibrous Ligament of Berry, that is, the true Ligament of Berry, with its safe relationship to the recurrent laryngeal nerve in Thyroidology.

Safety and Cost-effectiveness of LigaSure® in Total Thyroidectomy in Comparison with Conventional Suture Tie Technique

Introduction: Total thyroidectomy has been considered to be a treatment of choice for thyroid malignancies. It has recently gained popularity as gold standard for benign thyroid disorders requiring surgical treatment. Because of higher number of complications associated with total thyroidectomy, it is still considered an adventurous endeavor. Most important improvements in thyroid surgery include laparoscopic thyroidectomy, energy based devices (EBD) like Harmonic Focus® and LigaSure® for dissection and hemostasis, intraoperative neuromonitoring, and parathyroid hormone (PTH) assay technology.

Aim of Study: Recent studies have suggested that despite lesser complication rates with LigaSure dissection method in total thyroidectomy, it is associated with prolonged operation time. Aim of our study was to compare conventional suture tie technique and LigaSure thyroidectomy, in terms of perioperative complications including bleeding, recurrent laryngeal nerve (RLN) injury, postoperative hematoma, hypocalcemia, operation time, and cost-effectiveness. 

Results: This is a retrospective descriptive study done at Shifa Internationall Hospital/Shifa College of Medicine/Shifa Tameer e’ Millat University, Islamabad, Pakistan from 1st of June 2016 to 1st of June 2018. One hundred and two (102) patients who underwent surgical treatment for benign thyroid diseases were included in the study. Study was done after approval from ethical committee of Shifa International Hospital/Shifa Tameer e’ Millat University. Group A included patients in whom LigaSure was used for hemostasis and dissection during total thyroidectomy. Group B included patients who underwent total thyroidectomy by traditional clamp, tie, and electrocautery method for hemostasis and dissection. Frequency of female patients in group A was 45 (88.2%) and in group B was 41 (80.3%). In group A frequency of male patients was 9 (17.6%) and in group B it was 7 (13.7%). Mean operative time in group A was significantly lower (92 ± 9.61 min) than group B (123 ± 7.96 min). Mean intraoperative blood loss in group A was estimated to be 51.73 ± 5.65 mL and 139.42 ± 7.31 mL in group B. Transient hypocalcemia was the most common complication in both the groups. In group A 6.8% (n=7) patients developed transient postoperative hypocalcemia. Three patients in group B (2.9%) had transient hypocalcemia.

Conclusion: LigaSure was significantly advantageous over conventional technique in reducing risk of complications and operation time as well as perioperative and postoperative blood loss. The reduction of operative times resulted in decreased operating room occupancy costs but the overall cost of surgery was significantly higher in LigaSure group.