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      A meta-analysis comparing the outcomes of LigaSure Small Jaw versus clamp-and-tie technique or Harmonic Focus Scalpel in thyroidectomy

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          Abstract

          Background:

          LigaSure (LS) Small Jaw is a surgical hemostasis equipment that is newly introduced in thyroid surgery. The objective of this study is to assess the short-term efficacy and safety outcomes of LS Small Jaw compared with clamp-and-tie technique or Harmonic Focus Scalpel in thyroidectomy.

          Methods:

          A literature search was performed in the PubMed and Embase databases (until June 12, 2016) that reported the comparisons between LS Small Jaw and other techniques in thyroidectomy. Quality assessments were performed according to The Cochrane Collaboration's risk of bias tool and a modification of the Newcastle-Ottawa Scale in randomized controlled trials (RCTs) and non-RCTs, respectively. All statistical analyses were conducted using RevMan 5.3.

          Results:

          Finally, 7 studies with 813 patients were included into the meta-analysis, and all included studies were comparable with moderate-to-high quality. There was significant reduced operative time in LS Small Jaw, compared with clamp-and-tie (mean difference [MD] = −17.49, 95% confidence interval [CI]: −22.20 to 12.77, P < 0.00001) or Harmonic Focus Scalpel (MD = −2.29, 95% CI: −3.19 to 1.39, P < 0.00001). Besides, other perioperative outcomes including intraoperative blood loss and postoperative blood loss favored LS Small Jaw compared with clamp-and-tie. In terms of complications, less-temporary hypocalcemia rate was observed in LS Small Jaw compared with clamp-and-tie (odds ratio [OR] = 0.49, 95% CI: 0.27–0.90, P = 0.02), although no significant difference was detected compared with Harmonic Focus Scalpel (OR = 0.47, 95% CI: 0.14–1.56, P = 0.22). Other complications such as length of hospital stay, permanent hypocalcemia, temporary or permanent recurrent laryngeal nerve palsy, and hematomas were not significant.

          Conclusion:

          In conclusion, LS Small Jaw is more favorable than clamp-and-tie technique or Harmonic Focus Scalpel in thyroidectomy.

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          Most cited references15

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          Hemostasis in thyroid surgery: harmonic scalpel versus other techniques--a meta-analysis.

          Min Ho Choe, Thomas Ecker, Klaus Preuss … (2010)
          The objective is to systematically review the literature studying the harmonic scalpel versus other hemostatic techniques in thyroid surgical patients. Although thyroidectomy is one of the most common surgical procedures, the safest, most efficient, and cost-effective way to achieve hemostasis is hotly debated. We searched the electronic databases Medline and the Cochrane Library using relevant search strategies. Two reviewers (G.W., T.E.) independently assessed titles and abstracts of 72 identified studies. Twelve prospective randomized controlled studies were considered relevant and included in this meta-analysis (1153 patients). In all studies, operating time was reduced by using the harmonic scalpel. Compared with surgical hemostasis by suture ligation or suture/clip ligation combined with electrocauterization or electrothermal bipolar vessel sealer (n = 602), the mean operating time reduction for the harmonic scalpel was equivalent to 22.67 minutes (95% CI, -27.98; -17.37, P < 0.00001) or nearly 25 percent of the total operating room time. When harmonic scalpel was used, blood loss was reduced significantly by 20.03 mL (95% CI, -27.83; -12.22, P < 0.00001), and a mean reduction in postoperative pain (0.86 points [95% CI, -1.60; -0.13, P = 0.02]) was measured. Length of stay was reduced by 0.12 days (95% CI, -0.25; 0.00, P = 0.05). Differences regarding volume of drainage fluid were in favor of harmonic scalpel but not statistically significant; complications were similar in both groups. There is clear evidence that using the harmonic scalpel for hemostasis in thyroid surgery significantly reduces operating time and blood loss and that it is not associated with an increase in volume of drainage fluid, complication rate, or hospital stay. 2010 American Academy of Otolaryngology-Head and Neck Surgery Foundation. Published by Mosby, Inc. All rights reserved.
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            A multicenter, randomized, controlled clinical trial of LigaSure small jaw vessel sealing system versus conventional technique in thyroidectomy.

            Prakobkiat Hirunwiwatkul, Sutumma Tungkavivachagul (2013)
            The objective of this work was to compare efficacy and adverse effects between vessel sealing system thyroid lobectomy (VSSL) with the new LigaSure™ Small Jaw Instrument and conventional thyroid lobectomy (CTL). This is a multicenter, randomized and controlled study, conducted in the Department of Otolaryngology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Faculty of Medicine, Chulalongkorn University, Bangkok and Division of Otolaryngology, Sukhothai General Hospital, Sukhothai, Thailand. Forty subjects with solitary thyroid nodule planned for thyroid lobectomy were enrolled consecutively in both centers. Intervention was randomized by block randomization into two groups (VSSL, CTL). Primary outcomes were operative time and intraoperative blood loss. Secondary outcomes were postoperative blood loss and recurrent laryngeal nerve paralysis. There was clinically significant less operative time (VSSL/CTL = 62.4 ± 15.9/83.3 ± 16.1 min, p < 0.001) and less intraoperative blood loss (VSSL/CTL = 40.5 ± 19.1/63.3 ± 22.4 mL, p = 0.001) in VSSL group compared with CTL group. There was no significant difference of postoperative blood loss (VSSL/CTL = 58.8 ± 30.6/76.0 ± 36.9 mL, p = 0.116) between both the groups. There was one case of permanent recurrent laryngeal nerve injury found in both groups. VSSL with the new LigaSure™ Small Jaw Instrument was better than conventional technique in terms of shortening operative time. It was also better in reducing intraoperative hemorrhage, but this effect did not exceed clinically significant levels. Postoperative blood loss and recurrent laryngeal nerve injury were not significantly different between both the groups.
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              Hospital costs associated with thyroidectomy performed with a Harmonic device compared to conventional techniques: a systematic review and meta-analysis

              Jeffrey W. Clymer, Chris Cameron, Nicole Ferko … (2016)
              Harmonic devices have become a world-wide standard for dissection and hemostasis in thyroidectomy. Numerous systematic reviews have reported superior operating times, blood loss, post-operative pain, length of stay, and overall safety outcomes. What has not been extensively evaluated in a robust manner is their economic impact. The purpose of this study is to evaluate the hospital costs associated with open thyroidectomy using Harmonic devices compared with conventional techniques for hemostasis.
              Article 0 comments Cited 11 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Medicine (Baltimore)
                Journal ID (iso-abbrev): Medicine (Baltimore)
                Journal ID (publisher-id): MEDI
                Title: Medicine
                Publisher: Wolters Kluwer Health
                ISSN (Print): 0025-7974
                ISSN (Electronic): 1536-5964
                Publication date Collection: March 2017
                Publication date (Electronic): 24 March 2017
                Volume: 96
                Issue: 11
                Electronic Location Identifier: e6141
                Affiliations
                [a ]Department of Endocrinology, Sichuan Academy of Medical Science & Sichuan Provincial Hospital
                [b ]Department of Infection Disease, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China.
                Author notes
                [∗ ]Correspondence: Lei Zhang, Department of Endocrinology, Sichuan Academy of Medical Science & Sichuan Provincial Hospital, Chengdu 610032, China (e-mail: 1632147793@ 123456qq.com )
                Article
                Publisher ID: MD-D-16-05662 Accession ID: 06141
                DOI: 10.1097/MD.0000000000006141
                PMC ID: 5369883
                PubMed ID: 28296728
                SO-VID: 42bae97f-17f5-4429-a1c0-96178e39c80b
                Copyright © Copyright © 2017 the Author(s). Published by Wolters Kluwer Health, Inc.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc/4.0

                History
                Date received : 8 September 2016
                Date revision received : 20 January 2017
                Date accepted : 24 January 2017
                Categories
                Subject: 4300
                Subject: Research Article
                Subject: Systematic Review and Meta-Analysis
                Custom metadata
                OPEN-ACCESS TRUE

                Keywords: clamp-and-tie,complications,harmonic focus scalpel,ligasure small jaw,meta-analysis
                Data availability:
                Keywords: clamp-and-tie, complications, harmonic focus scalpel, ligasure small jaw, meta-analysis

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