Print ISSN: 1683-3589

Online ISSN: 2409-501X

Keywords : THYROIDECTOMY


SAFETY AND EFFICACY OF THE BIPOLAR RADIOFREQUENCY ABLATION DEVICE FOR HEMOSTASIS IN THYROIDECTOMY IN COMPARISON WITH THE CONVENTIONAL KNOT-TYING TECHNIQUE

Basrah Journal of Surgery, Volume 24, Issue 1, Pages 20-26
DOI: 10.33762/bsurg.2018.160104

SAFETY AND EFFICACY OF THE BIPOLAR RADIOFREQUENCY ABLATION DEVICE FOR HEMOSTASIS IN THYROIDECTOMY IN COMPARISON WITH THE CONVENTIONAL KNOT-TYING TECHNIQUE

Sadq Ghaleb Kadem*, Sarmad Manea Habash# & Mohammed Khalaf Raheem@ *#@MB,ChB, FICMS, Department of Surgery, Al-Shiffa General Hospital, Basrah, IRAQ

Abstract The conventional method of hemostasis by using knot-tying technique is safe and effective in thyroid surgery but it is time consuming. A new energy devices like ultrasonic scalpel and advanced bipolar electrosurgical cautery have been proven to be safe and effective in shortening the length of thyroid surgery but the high cost of these advanced generators that designed to work only with an expensive disposable hand pieces, make its use difficult to justify in some hospitals. Radiofrequency ablation device is a refined type of electrosurgical cautery that utilizes a wave of electrons at a frequency between 2 and 4MHz to seal and divide the targeted tissue and the ablation property of this device act as an extra vessel sealing effect, it can be used with conventional reusable bipolar electrosurgical cautery hand pieces. The aim is to evaluate the safety and efficacy of a simple bipolar radiofrequency ablation device for hemostasis in thyroidectomy in comparison with the conventional knot-tying technique. This study was conducted in Alshiffa General Hospital following the approval of the local ethical committee. Fifty patients with different thyroid gland pathologies underwent total thyroidectomy in which hemostasis was achieved mainly with bipolar radiofrequency ablation device. The results of this group were compared with results of conventional knot-tying technique by the same surgical team at an earlier period. This study showed that bipolar radiofrequency ablation device significantly reduced; mean operative time, amount of foreign suture material, significant reduction in the mean volume of postoperative drainage, early patient discharge from hospital, and less complications. In conclusion, the use of the bipolar radiofrequency ablation device with conventional reusable bipolar cautery forceps for hemostasis in thyroidectomy is a safe, simple technique and effective in reducing the operative time in comparison with the conventional knot-tying technique.

ULTRASONIC DISSECTION VERSUS CONVENTIONAL LIGATION COAGULATION IN THYROIDECTOMY

Abdulameer Muhsin Aldaraji

Basrah Journal of Surgery, Volume 23, Issue 1, Pages 66-75
DOI: 10.33762/bsurg.2017.132425

ULTRASONIC DISSECTION VERSUS CONVENTIONAL LIGATION COAGULATION IN THYROIDECTOMY

Abdulameer Muhsin Aldaraji
MB, ChB, FICMS, General Surgeon, Al-Faiha General Hospital, Basrah, IRAQ.

Abstract
Ligation and diathermy coagulation was the standard method of hemostasis in thyroid surgery for more than a century. New hemostatic techniques were developed in the 1990th. Ultrasonic dissector used for the first time in thyroidectomy in 1999 by Tokami. Many studies compared the conventional method of thyroidectomy with new ultrasonic dissector technique. These studies found many advantages of the new method including reduction of operative time, shorter incision, decrease blood loss, decrease post operative drainage, shorten hospital stay and decrease complications. This study compared the two methods of hemostasis regarding incision length, operative time and complications.
Between March 2012 and March 2015, 143 patients underwent open thyroidectomy involved in a prospective study at Al-Faiha General Hospital. The patients were divided into 2 groups: Group 1, conventional thyroidectomy technique(clamp, tie and diathermy coagulation) included 104 patients. Group 2, ultrasonic dissection technique (sutureless thyroidectomy) included 39 patients. The patient characteristic and postoperative complications were reported. The incision length and the operative time was measured. All patients underwent surgery by the routine pre tracheal strap muscle cutting transeversly (not splitting). In group 2, the ultrasonic dissector was used in strap muscle cutting, sealing §ion of the blood vessels and in the final resection of the gland.
The surgical incision length and operative time were compared in both groups. In lobectomy, there was no significant reduction in the length of incision with use of ultrasonic dissector( z value<1.96)(p >0.05), while in subtotal, total or near total thyroidectomy there was significant reduction in the length of incision (p value<0.05) with use of ultrasonic dissector. There was significant reduction of operative time (p value<0.05) in lobectomy and total or near total thyroidectomy with use of ultrasonic dissector as compared to conventional thyroidectomy technique. There was no significant difference in the complications in both techniques apart from increased incidence of temporary recurrent laryngeal nerve paralysis in ultrasonic dissector technique (9.2% in USDT v s 3.7% in CT of thyroidectomy).
This study found significant reduction of the surgical incision size similar to that obtained by Fabrizo who stated that thyroidectomy can be done with shorter incision. This improve patient satisfaction and cosmetic outcome. The operative time was significantly reduced in lobectomy, total or near total thyroidectomy by the use of ultrasonic dissector technique(USDT) as compared to the conventional technique (CT){lobectomy 44 minutes vs 55 minutes, total thyroidectomy 57 minutes vs 80 minutes}. Similar results were obtained by many other studies such as Micoli et al & Siperstein et al. this may save utilization of operation theatre and decrease waiting list. The USDT is safe as far as the complication rate was similar to that of CT apart from increase the incidence of temporary recurrent laryngeal nerve paralysis. Many studies confirmed the safety of USDT such as that of Tokami, Micolli, Siperstein etc .
In conclusion, thyroidectomy can be performed safely by the USDT with advantage of smaller incision & shorter operative time as compared to conventional technique.

IMPACT OF THE HARMONIC SCALPEL HEMOSTASIS IN TOTAL THYROIDECTOMY IN COMPARISON WITH CONVENTIONAL HEMOSTATIC TECHNIQUE

Sadq Ghaleb Kadem; Raheem Sharhan Balasim

Basrah Journal of Surgery, Volume 22, Issue 2, Pages 63-68
DOI: 10.33762/bsurg.2016.116615

Abstract Traditional haemostatic technique in thyroidectomy may cause some damages to surrounding tissues and it is time consuming. It is believed that these damages and the time can be reduced using ultrasonic dissector devices like Harmonic Scalpel. In this study, we investigate the benefits of harmonic Scalpel haemostasis (HS) versus conventional haemostatic techniques (CT) in total thyroidectomy. Analysis of patient’s data was done for cases with total thyroidectomies performed between 2011and 2015 by the same surgeons using either the conventional technique (Clamp and Tie technique) or the harmonic scalpel for haemostasis. Gender, age, preoperative clinical information, histopathology results,and procedure type were analyzed. and according to the type of haemostatic techniques the collected patient’s data was divided in to two groups; conventional group (CT group) in which the haemostasis was done with Clamp and Tie technique and harmonic scalpel group (HS group) in which the haemostasis was done with Harmonic Scalpel (Sonicbeat Olympus). The outcome and the complications of the both procedures were analyzed statistically and compared. The use of harmonic scalpel in total thyroidectomy significantly decreases mean operative time by (-37.635 min) 60.49±7.78 SD for HS group vs 98.13±14.165 SD for CT group with very significant P-value (0.0000). Statistical significant difference in the mean volume of postoperative drainage in (ml) through redivac drain observed between the two groups; 63.02±19.91SD for HS group and 72.50±22.79 SD for CT group with significant P-value (0.0000). There were no significant difference in the other parameters of the outcome and complications after total thyroidectomy in both groups. It is concluded from this study that main impact of harmonic scalpel in total thyroidectomy is the significant reduction in operative time and its use is safe and not associated with increase in the rate of the complications.