Thyroidectomy With Ultrasonic Dissector: A Multicentric Experience

Introduction. We have conducted a clinical controlled trial (CCT) on patients who had undergone thyroidectomy for goitre or thyroid carcinoma. The endpoint of this study was to evaluate the benefits of ultrasonic dissector vs conventional technique (vessel ligation and tight) in patients undergoing thyroid surgery.Patients and methods. Between January 2007 and December 2009 a CCT was conducted on 2.736 consecutive patients admitted to our clinical wards, who had undergone thyroidectomy for goitre or thyroid carcinoma. They were divided in two groups: 1.021 patients (203 male and 818 female) underwent thyroidectomy with ultrasonic dissector (UAS) and 1.715 patients (369 male and 1.346 female) underwent thyroidectomy with conventional technique (vessel legation and tight) (CT).Results. The operative time (UAS 80 minutes mean, 50 to 120 min., vs CT 120 minutes, 70 to 180 minutes) was much lower in the thyroidectomy with UAS group. The incidence of transient laryngeal nerve palsy (UAS 17/1.021 patients, 1.6%, vs CT 16/1.715 patients, 0.9%) was higher in the thyroidectomy with UAS group; the incidence of permanent laryngeal nerve palsy was similar in two groups (UAS 9/1.021 patients, 0.9%, vs CT 18/1.715 patients, 1%). The incidence of transient hypocalcemia (UAS 98/1.021 patients, 9.5%, vs CT 132/1.715 patients, 7.7%) was higher in the thyroidectomy with UAS group; there are no relevant differences in the incidence of permanent hypocalcemia (UAS 26/1.021 patients, 2.5%, vs 35/1.715 patients, 2%) which was similar in two groups. Also the average post-operative hospitalization was similar in two groups (2 days).Conclusion. Actually, the only significant advantage shown from this CCT is represented in terms of cost-effectiveness (reduction of the usage of operating room and hospitalization) for patients treated with UAS, subsequent to the significant reduction of operative duration. Although the analysis showed that the patients who were treated with ultrasonic dissector don't present more favourable results in incidence of post- operative transient complications: transient laryngeal nerve palsy (1.6% in UAS vs 0.9% in CT) and transient hypocalcaemia (9.5% in UAS vs 7.7% in CT). There is no significant difference in the incidence of permanent laryngeal nerve palsy (0.9% in UAS vs in 1% CT) and permanent hypocalcaemia (2.5% in UAS vs 2% in CT). The experience of surgeon is the only important factor which can influence the appearance of these complications; the usage of Ultrasonic dissector can only help surgical action but can't replace the experience of the operator.