[Implementation of a Vessel Sealing Device in a Centre for Thyroid Surgery: Risk and Economic Profit].

BACKGROUND

This study investigated whether the use of the vessel sealing device LigaSure Small Jaw™ is cost-effective and safe in thyroid surgery despite the high cost of material.

PATIENTS AND

METHODS

We analysed the results of 224 thyroid operations performed by the same surgeon in three time intervals. We included thyroidectomies and bilateral near-total resections (including Dunhill surgery). Minimally-invasive resections (MIVAT), unilateral resections or subtotal resections (remains > 2 ml), patients with recurrent goiter, operations with neck dissections and sternotomies were excluded. In 72 procedures carried out during the first interval (1/2011 - 6/2011), the surgeon only used the clamp-and-tie technique. In the other two intervals (II: 7/2012 - 12/2012, n = 81 and III: 1/2014 - 6/2014: n = 71), the LigaSure Small Jaw was used. We investigated operation time (cut-seam time) and the complication rates between the groups (transient/permanent laryngeal nerve palsy, severe bleeding causing reoperation and hypocalcaemia, defined as Ca < 2.0 mmol/l). Differences were calculated with the t-test and the Wilcoxon rank test. Values are given as mean ± SEM.

RESULTS

Specimen weight and the indication for surgery (nodular goiter or Basedow's disease) were comparable in all groups, but there were fewer thyroidectomies performed in the first interval (p = 0.009). There was no difference in complication rates between the groups, such as the rate of transient laryngeal nerve palsy in % (I: 2.17; II: 1.92; III 1.44) and postoperative hypocalcaemia in % (I: 20.8; II: 21.0; III 15.5). The use of the LigaSure Small Jaw in thyroidectomy procedures led to a significant reduction of operation time (II: Δ 27.4 min; III: Δ 25.6 min; p = 0.0001) compared to interval I. This was also found for bilateral near-total resections (II: Δ 24.3 min; III Δ 32.1 min; p = 0.0001). The InEK calculation for thyroidectomy procedures estimated personnel expenses in the OR to be about 1233 €. A 31-min reduction in operation time would save 440 € of personnel expenses.

DISCUSSION: The use of the LigaSure Small Jaw during thyroid surgery is safe and cost-effective for thyroidectomy procedures and bilateral near-total resections.