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

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.