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Journal Information
Vol. 62. Issue 5.
Pages 339-346 (September - October 2011)
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Vol. 62. Issue 5.
Pages 339-346 (September - October 2011)
Original article
Hemostatic Systems in Thyroid Surgery and Complications
Sistemas de hemostasia en cirugía tiroidea y complicaciones
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3027
José Luis Pardal-Refoyo
Servicio de Otorrinolaringología, Sección de Cirugía Tiroidea y Paratiroidea, Hospital Virgen de La Concha, Zamora, Spain
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Tables (4)
Table 1. Distribution of the Sample.
Table 2. Definition of Terms Used.
Table 3. Complications and Outcomes of the Surgical Activity.
Table 4. Relative Risk Calculated for Each Group.
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Abstract
Introduction

There have been significant technological advances for hemostasis in thyroid surgery, that allow more precise and safer vascular sealing than the traditional bond associated with mono- or bipolar electrocoagulation.

Objective

To compare the complications in total thyroidectomy using traditional techniques (ligation and electrocoagulation, including LigaSure) compared to the exclusive use of the Ultracision Harmonic scalpel, performing dissection, cutting and hemostasis simultaneously.

Methods

Retrospective descriptive non-randomised comparative study with 887 patients who underwent total thyroidectomy by the same surgeon. They were distributed into Group A (traditional techniques in 468 patients, January 1997 to September 2006) and Group B (Harmonic Ultracision in 419 patients, October 2006 to May 2010).

Results

There was a statistically significant lower incidence of complications in Group B (0.95% versus 4.06% in group A): bleeding (0.24% versus 1.92% in group A), tracheostomy (0% versus 1.28%) and intensive care unit stay (0% versus 4.06%). Improvement of surgical activity parameters was also significant for Group B: shorter operation time (60min versus 180min), fewer hospital stays (4.62 versus 8.5 stays) and increase in operations per month (9.63 versus 4 interventions). Persistent sequelae (recurrent paralysis [0.48%] and hypoparathyroidism [0.47%]) decreased in the second group but the difference was not statistically significant compared to Group A. The cost per patient was lower in Group B.

Conclusions

The Ultracision Harmonic scalpel system is the technique of choice for thyroid surgery.

Keywords:
Thyroid
Thyroidectomy
Complications
Hemostasis
Surgery
Harmonic
Scalpel
Resumen
Introducción

Los avances tecnológicos en hemostasia permiten el sellado vascular con mayor precisión y seguridad que la tradicional ligadura asociada a la electrocoagulación mono o bipolar.

Objetivo

Comparar las complicaciones en tiroidectomía total mediante técnicas tradicionales (ligadura, electrocoagulación, incluido Ligasure), frente al uso exclusivo de Harmonic Ultracision que realiza disección, corte y hemostasia simultáneamente.

Métodos

Estudio retrospectivo, descriptivo, comparativo, no aleatorio en 887 pacientes sometidos a tiroidectomía total por el mismo cirujano. Se distribuyen en grupo A (técnicas tradicionales en 468 pacientes, enero de 1997 a septiembre de 2006) y grupo B (Harmonic Ultracision en 419 pacientes, octubre de 2006 a mayo de 2010).

Resultados

En el grupo B se produjeron significativamente menos complicaciones (incidencia global de 0,95 frente al 4,06 en el grupo A): hemorragia (0,24 frente a 1,92% en grupo A), traqueotomía (0 frente a 1,28%) y estancia en UCI (0 frente a 4,06%). Hubo mejora de los parámetros de actividad: menor tiempo quirúrgico (60 frente a 180 minutos), menor estancia hospitalaria (4,62 frente a 8,5 estancias), incremento del número de intervenciones mensuales (9,63 frente a 4 intervenciones). Las secuelas persistentes en el grupo B (parálisis recurrencial −0,48%− e hipoparatiroidismo −0,47%−) disminuyeron pero sin diferencia estadísticamente significativa respecto al grupo A. El coste por paciente es inferior en el grupo B.

Conclusiones

El sistema Harmonic Ultracision es la técnica de elección en cirugía tiroidea.

Palabras clave:
Tiroidectomía
Complicaciones
Hemostasia
Cirugía
Bisturí
Armónico

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