Does using an energized device in open thyroidectomy reduce complications?

BACKGROUND

Although using energy devices during open thyroidectomy might shorten the procedure time compared with the conventional technique, its effect on procedure-related complications remains unclear and controversial. In an era of cost containment, we aimed to compare the rate of procedure-related complications (particularly vocal cord palsy and hypoparathyroidism) between patients who underwent thyroidectomy using reusable ultrasonic shears and those who did not.

METHODS

Of 508 eligible patients, 237 (46.7%) underwent thyroidectomy using the SonoSurg (reusable ultrasonic shears; SonoSurg group) and 271 (53.3%) underwent thyroidectomy using the conventional technique (suture ligation and clips; conventional technique group). The reusable shears were autoclaved at the end of each procedure and replaced after every 20 cases. To evaluate the effect of the ultrasonic shears on procedure-related complications, the patient characteristics and outcomes were compared between the 2 groups.

RESULTS

In the SonoSurg group, the total operating time (60 min versus 105 min, P < 0.001) and temporary (12.4% versus 25.5%, P = 0.009) and permanent hypoparathyroidism (1.9% versus 9.8%, P = 0.003) rates were significantly less than those in the conventional technique group. The permanent vocal cord palsy rate was similar (P = 0.262). On multivariate analysis, using the reusable shears (odds ratio 0.163; 95% confidence interval 0.047-0.570; P = 0.005) and parathyroid autotransplantation of at least 1 gland (odds ratio 0.370; 95% confidence interval 0.146-0.943; P = 0.037) were the 2 independent variables for permanent hypoparathyroidism after completion/total thyroidectomy.

CONCLUSIONS

Using the reusable shears during open thyroidectomy was significantly associated with a shortened operating time and lower permanent hypoparathyroidism rate, although the vocal cord palsy rate remained similar.