Comparison of hypocalcemia rates between LigaSure and clamp-and-tie hemostatic technique in total thyroidectomies
Feng-Yu Chiang MD
Department of Otolaryngology—Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
Search for more papers by this authorKang Dae Lee MD, PhD
Department of Otolaryngology—Head and Neck Surgery, College of Medicine, Kosin University, Busan, South Korea
Search for more papers by this authorKyung Tae MD, PhD
Department of Otolaryngology—Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, South Korea
Search for more papers by this authorRalph P. Tufano MD, PhD
Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorChe-Wei Wu MD, PhD
Department of Otolaryngology—Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
Search for more papers by this authorI-Cheng Lu MD, PhD
Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
Search for more papers by this authorPi-Ying Chang MD
Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
Search for more papers by this authorYi-Chu Lin MD
Department of Otolaryngology—Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
Search for more papers by this authorCorresponding Author
Tzu-Yen Huang MD
Department of Otolaryngology—Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
Correspondence
Tzu-Yen Huang, MD, Department of Otolaryngology–Head and Neck Surgery, Kaohsiung Medical University Hospital, 100 Tzyou First Road, Kaohsiung 807, Taiwan.
Email: [email protected]
Search for more papers by this authorFeng-Yu Chiang MD
Department of Otolaryngology—Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
Search for more papers by this authorKang Dae Lee MD, PhD
Department of Otolaryngology—Head and Neck Surgery, College of Medicine, Kosin University, Busan, South Korea
Search for more papers by this authorKyung Tae MD, PhD
Department of Otolaryngology—Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, South Korea
Search for more papers by this authorRalph P. Tufano MD, PhD
Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorChe-Wei Wu MD, PhD
Department of Otolaryngology—Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
Search for more papers by this authorI-Cheng Lu MD, PhD
Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
Search for more papers by this authorPi-Ying Chang MD
Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
Search for more papers by this authorYi-Chu Lin MD
Department of Otolaryngology—Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
Search for more papers by this authorCorresponding Author
Tzu-Yen Huang MD
Department of Otolaryngology—Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
Correspondence
Tzu-Yen Huang, MD, Department of Otolaryngology–Head and Neck Surgery, Kaohsiung Medical University Hospital, 100 Tzyou First Road, Kaohsiung 807, Taiwan.
Email: [email protected]
Search for more papers by this authorAbstract
Background
Postoperative hypocalcemia (PH) is a serious complication after total thyroidectomy. This study aimed to compare PH rates between LigaSure Small Jaw (LSJ) and clamp-and-tie hemostatic technique in patients undergoing total thyroidectomy.
Methods
Four hundred twenty patients were divided into two groups: group L (210 patients) performed with LSJ and group C (210 patients) with clamp-and-tie technique. Serum ionized calcium (iCa) was measured before and 12, 24, 48, 72 hours after surgery. PH was defined as iCa lower than 4.2 mg/dL in at least two measurements.
Results
There was no significant difference between groups in sex, age, extent of surgery, pathology, and the strategy of intraoperative management of parathyroid glands (PG). The PH rate was significantly lower in group L compared to group C (22.9% vs 32.4%, P = .03).
Conclusions
Compared to clamp-and-tie technique, LigaSure is superior to decrease PH rate after total thyroidectomy.
REFERENCE
- 1Wilson RB, Erskine C, Crowe PJ. Hypomagnesemia and hypocalcemia after thyroidectomy: prospective study. World J Surg. 2000; 24(6): 722-726.
- 2Vrachimis A, Wenning C, Gerss J, et al. Not all DTC patients with N positive disease deserve the attribution "high risk". Contribution of the MSDS trial. J Surg Oncol. 2015; 112(1): 9-14.
- 3Pergel A, Yucel AF, Aydin I, Sahin DA, Aras S, Kulacoglu H. A safety-based comparison of pure LigaSure use and LigaSure-tie technique in total thyroidectomy. Chirurgia (Bucur). 2014; 109(1): 60-65.
- 4Franko J, Kish KJ, Pezzi CM, Pak H, Kukora JS. Safely increasing the efficiency of thyroidectomy using a new bipolar electrosealing device (LigaSure) versus conventional clamp-and-tie technique. Am Surg. 2006; 72(2): 132-136.
- 5Yao HS, Wang Q, Wang WJ, Ruan CP. Prospective clinical trials of thyroidectomy with LigaSure vs conventional vessel ligation: a systematic review and meta-analysis. Arch Surg. 2009; 144(12): 1167-1174.
- 6Contin P, Goossen K, Grummich K, et al. ENERgized vessel sealing systems versus CONventional hemostasis techniques in thyroid surgery—the ENERCON systematic review and network meta-analysis. Langenbecks Arch Surg. 2013; 398(8): 1039-1056.
- 7Chang LY, O'Neill C, Suliburk J, Sidhu S, Delbridge L, Sywak M. Sutureless total thyroidectomy: a safe and cost-effective alternative. ANZ J Surg. 2011; 81(7–8): 510-514.
- 8Singh P, O'Connell D, Langille M, Dziegielewski P, Allegretto M, Harris J. LigaSure versus conventional hemostasis in thyroid surgery: prospective randomized controlled trial. J Otolaryngol Head Neck Surg. 2010; 39(4): 378-384.
- 9Cakabay B, Sevinc MM, Gomceli I, Yenidogan E, Ulku A, Koc S. LigaSure versus clamp-and-tie in thyroidectomy: a single-center experience. Adv Ther. 2009; 26(11): 1035-1041.
- 10Petrakis IE, Kogerakis NE, Lasithiotakis KG, Vrachassotakis N, Chalkiadakis GE. LigaSure versus clamp-and-tie thyroidectomy for benign nodular disease. Head Neck. 2004; 26(10): 903-909.
- 11Calvo Espino P, Rivera Bautista JA, Artes Caselles M, et al. Serum levels of intact parathyroid hormone on the first day after total thyroidectomy as predictor of permanent hypoparathyroidism. Endocrinol Diabetes Nutr. 2019; 66(3):195-201.
- 12Wang W, Xia F, Meng C, Zhang Z, Bai N, Li X. Prediction of permanent hypoparathyroidism by parathyroid hormone and serum calcium 24h after thyroidectomy. Am J Otolaryngol. 2018; 39(6): 746-750.
- 13Eismontas V, Slepavicius A, Janusonis V, et al. Predictors of postoperative hypocalcemia occurring after a total thyroidectomy: results of prospective multicenter study. BMC Surg. 2018; 18(1): 55.
- 14Lorente-Poch L, Sancho JJ, Ruiz S, Sitges-Serra A. Importance of in situ preservation of parathyroid glands during total thyroidectomy. Br J Surg. 2015; 102(4): 359-367.
- 15Mathur A, Nagarajan N, Kahan S, Schneider EB, Zeiger MA. Association of parathyroid hormone level with postthyroidectomy hypocalcemia: a systematic review. JAMA Surg. 2018; 153(1): 69-76.
- 16Chand G, Agarwal S, Mishra A, et al. The impact of uniform capsular dissection technique of total thyroidectomy on postoperative complications: an experience of more than 1000 total thyroidectomies from an endocrine surgery training centre in North India. Indian J Endocrinol Metab. 2018; 22(3): 362-367.
- 17Ahmed N, Aurangzeb M, Muslim M, Zarin M. Routine parathyroid autotransplantation during total thyroidectomy: a procedure with predictable outcome. J Pak Med Assoc. 2013; 63(2): 190-193.
- 18Testini M, Rosato L, Avenia N, et al. The impact of single parathyroid gland autotransplantation during thyroid surgery on postoperative hypoparathyroidism: a multicenter study. Transplant Proc. 2007; 39(1): 225-230.
- 19Lo CY, Lam KY. Routine parathyroid autotransplantation during thyroidectomy. Surgery. 2001; 129(3): 318-323.
- 20Lo CY. Parathyroid autotransplantation during thyroidectomy. ANZ J Surg. 2002; 72(12): 902-907.
- 21Sitges-Serra A, Lorente-Poch L, Sancho J. Parathyroid autotransplantation in thyroid surgery. Langenbecks Arch Surg. 2018; 403(3): 309-315.
- 22Lorente-Poch L, Sancho J, Munoz JL, Gallego-Otaegui L, Martinez-Ruiz C, Sitges-Serra A. Failure of fragmented parathyroid gland autotransplantation to prevent permanent hypoparathyroidism after total thyroidectomy. Langenbecks Arch Surg. 2017; 402(2): 281-287.
- 23Tartaglia F, Blasi S, Giuliani A, et al. Parathyroid autotransplantation during total thyroidectomy. Results of a retrospective study. Int J Surg. 2016; 28(Suppl 1): S79-S83.
- 24Garas G, Okabayashi K, Ashrafian H, et al. Which hemostatic device in thyroid surgery? A network meta-analysis of surgical technologies. Thyroid. 2013; 23(9): 1138-1150.
- 25Chavez KV, Barajas EM, Soroa F, et al. Safety assessment of the use of ultrasonic energy in the proximity of the recurrent laryngeal nerve in a porcine model. Am J Surg. 2018; 215(1): 186-190.
- 26Dionigi G, Chiang FY, Kim HY, et al. Safety of LigaSure in recurrent laryngeal nerve dissection-porcine model using continuous monitoring. Laryngoscope. 2017; 127(7): 1724-1729.
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