الفهرس 
Surgical Anatomy andOnly 14 pages are availabe for public view
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Abstract
Thyroid surgery involves meticulous devascularization of the thyroid gland which has one of the richest blood supplies among the organs, with numerous blood vessels and plexuses entering its parenchyma. Therefore, hemostasis is of paramount importance to control and divide various vessels before excision of the gland.
The LigasureTM Vessel Sealing System (LVSS) (Valley Lab, Boulder, Co) is a new hemostatic device, primarily designed for use in abdominal surgery. It is a bipolar electrosurgical device, sealing vessels up to 7mm in diameter, by denaturing collagen and elastin within vessel wall and surrounding connective tissue. It applies a precise amount of energy to vessel walls while they are being held in tight apposition under pressure to produce a unique seal of partially denatured protein. A feedback-control mechanism with automatic ‘‘off ’’ switch, when impedance reaches a critical level, ensures that tissues are not charred by overcoagulation. Seal integrity in vessels 3 to 7 mm in diameter approximates the burst strength of ligatures and clips while it resists dislodgment and improves ease of dissection, because it requires minimal surgical dissection before application, and no foreign material is left behind.
Sealing is achieved with minimal sticking and charring; thus a limited amount of energy is delivered, resulting in a minimal thermal spread to adjacent tissues, of approximately 0.5 to 2mm.This is a particularly important property in thyroid surgery, because it allows for safe vascular ligation with minimal risk for damage to the recurrent laryngeal nerve, the external branch of the superior laryngeal nerve, and parathyroid glands.
This work aimed to evaluate the safety, efficacy, incidence of complications and surgical outcome in patients underwent total thyroidetomy using the ligasure versus the conventional clamp and tie technique.
Our work comprised 60 patients with different thyroid pathologies who were presented to us in Ain Shams University hospitals during the period of this study (2 years) suffering from thyroid swelling or thyrotoxic manifestations or both.
All patients had been subjected to full clinical assessment, routine laboratory studies, thyroid profile, neck US, indirect laryngoscopy and FNAC and thyroid scan when indicated and no patient was allowed to be operated upon unless becomes adequately prepared and euthyroid.
All our patients were candidates for surgical interference and all were operated upon by total thyroidectomy. All patients had been followed up postoperatively for at least 3 months or more in complicated cases.
In this study, the LigaSure vessel sealing system was easy to use and reliable; no technical difficulties were noted. It simplified total thyroidectomy, eliminating the need for clamp-and-tie maneuvers while achieving efficient hemostasis.
An important issue concerning the use of this new sealing modality is the extent of lateral thermal spread and associated tissue injury. Several experimental studies, however, have proved that this extent is minimal (from 0 to 3 mm) and, moreover, all the reported studies in the literature show that it can be used safely in thyroid surgery with no increase in complication rates. The safety of using this device in thyroid surgery also was shown in our study.
This study results demonstrated that the LigaSure vessel sealing system is a safe and effective hemostatic device allowing reduction in the operative time and intraoperative blood loss compared to the conventional clamp and tie technique, without increasing the incidence of transient and permanent postoperative complications.
The use of the electrothermal bipolar vessel sealer in thyroid surgery seems to be more expensive than the conventional technique. This is probably the major disadvantage of this device; however, the potential added cost to the procedure by using this device should be compared with the substantial benefit in surgical time savings. The ability to treat more patients in the same surgical session (in our series, in the same time that 4 thyroidectomies were performed using ligations, 5 thyroidectomies were performed using the Ligasure ) and the increased comfort for the surgeons because of the shortened surgical time also should be emphasized. In addition, time-saving surgeries are becoming an increasingly important issue, especially for the turnover of patients in hospitals and for using less anesthesia and shorter surgical time. The aforementioned benefits obtained by the use of this device may make it cost effective.