Total thyroidectomy: Ligasure versus Clamp & Knot technique for intraoperative hemostasis

ObjectivesTo evaluate the outcome of Ligasure-assisted total thyroidectomy as regards feasibility, intraoperative and postoperative complications, postoperative pain and hospital stay versus conventional thyroidectomy.Patients and MethodsThe study included 30 females with mean age of 45.3 ± 13.8 years and had varied thyroid lesions. All patients had clinical assessment, sonographic examination of the neck and laboratory investigations. Patients were randomly allocated into two equal groups: Group C included patients assigned for conventional thyroidectomy using tie and knot for hemostasis and Group L included patients assigned for thyroidectomy using Ligasure for hemostasis. Operating time, the incidence of intraoperative and postoperative complications, duration of wound drainage and hospital stay were determined. Subjective wound pain was evaluated using a 10-point visual analog scale (VAS) with 0 = no pain and 10 = worst intolerable pain. Postoperative analgesia was supplied at VAS score of 4.ResultsAll surgeries were conducted uneventfully without evident intraoperative morbidities. Mean intraoperative blood loss was less, but operative time was significantly reduced in group L compared to group C. Temporary unilateral recurrent laryngeal nerve (RLN) injury in three cases (10%) and clinically apparent hypocalcemia in four patients were detected (13.3%). The use of ligasure was advantageous and significantly reduced postoperative bleeding and the frequency of hypocalcemia compared to conventional surgical procedure. Patients of group L showed significantly lower pain VAS scores throughout the first three postoperative days with a significantly lower frequency of requests and consumption of rescue analgesia compared to group C. Wound drainage duration and total hospital stay were significantly reduced with a significantly higher frequency of patients discharged earlier in group L compared to group C.ConclusionLigasure hemostasis during total thyroidectomy improved surgical outcome with significantly reduced operative time, wound drainage duration and hospital stay. Moreover, ligasure use significantly reduced wound pain scores and requests for rescue analgesia.