Gland surgery · 2024
Comparison of thyroid surgery techniques: a retrospective cohort study and meta-analysis of traditional electric knife vs. straight bipolar electrocoagulation forceps.
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Zhang Shiwen, Huang Renchao, Qiu Youyu, Li Xiaojiang, Zhao Liufang, Xu Hongyang, Hai Yun, Wang Hao, Zhang Lu, Dong Zichen, An Changming
Аннотация
BACKGROUND: In recent years, advancements in surgical techniques for thyroidectomy have led to varying outcomes and efficiencies. Understanding these differences is crucial to optimize patient care and surgical success. This study compared intra- and postoperative parameters of thyroid surgery for thyroidectomy or thyroid cancer. One approach involved the traditional electric knife, employing traditional clamp-ligation skills and an electric knife. The other approach utilized straight bipolar electrocoagulation forceps for micro-hemostasis and micro-cutting.
METHODS: Data were analyzed retrospectively for 228 patients who underwent thyroidectomy at the Third Affiliated Hospital of Kunming Medical University from January 2014 to November 2018. Surgery was performed either as traditional open surgery (n=150) or as a meticulous anatomical procedure involving bipolar electrocoagulation (n=78). In addition, data from published studies comparing the two surgical procedures were meta-analyzed.
RESULTS: The bipolar electrocoagulation procedure was associated with significantly shorter total operation time, lower intraoperative blood loss and lower rate of hypocalcemia. The two procedures were associated with similar rates of hoarseness. Meta-analysis of eight studies involving 2,080 patients showed that bipolar electrocoagulation was associated with significantly shorter total operation time than the traditional approach (mean difference =-21.29 min, 95% CI: -26.32 to -16.27) and with less intraoperative bleeding (mean difference =-12.87 min, 95% CI: -23.81 to -1.93).
CONCLUSIONS: Straight bipolar electrocoagulation forceps can be used to perform fine dissection during thyroid surgery. Performing "micro-hemostasis" and "micro-cutting" manipulations with these straight bipolar forceps can smoothly dissect nerves and parathyroid glands and may reduce intraoperative bleeding, operation time and rates of postoperative complications, might accelerate recovery after surgery.
METHODS: Data were analyzed retrospectively for 228 patients who underwent thyroidectomy at the Third Affiliated Hospital of Kunming Medical University from January 2014 to November 2018. Surgery was performed either as traditional open surgery (n=150) or as a meticulous anatomical procedure involving bipolar electrocoagulation (n=78). In addition, data from published studies comparing the two surgical procedures were meta-analyzed.
RESULTS: The bipolar electrocoagulation procedure was associated with significantly shorter total operation time, lower intraoperative blood loss and lower rate of hypocalcemia. The two procedures were associated with similar rates of hoarseness. Meta-analysis of eight studies involving 2,080 patients showed that bipolar electrocoagulation was associated with significantly shorter total operation time than the traditional approach (mean difference =-21.29 min, 95% CI: -26.32 to -16.27) and with less intraoperative bleeding (mean difference =-12.87 min, 95% CI: -23.81 to -1.93).
CONCLUSIONS: Straight bipolar electrocoagulation forceps can be used to perform fine dissection during thyroid surgery. Performing "micro-hemostasis" and "micro-cutting" manipulations with these straight bipolar forceps can smoothly dissect nerves and parathyroid glands and may reduce intraoperative bleeding, operation time and rates of postoperative complications, might accelerate recovery after surgery.