LigaSure versus clamp-and-tie in thyroidectomy: a single-center experience

LigaSure (ValleyLab, CO, USA) is a bipolar diathermy system that seals vessels with reduced thermal spread. The device has been used successfully in abdominal surgery and has been introduced as a new method for hemostasis during thyroidectomy. This study compares the efficacy and advantages of LigaSure, when used for thyroidectomy in benign nodular thyroid disease, with the conventional clamp-and-tie technique. Between December 2003 and December 2008, 410 patients underwent thyroid surgery (333 with the conventional clamp-and-tie technique and 77 with LigaSure). Nine patients did not sign the ethical approval document and so were excluded from the study; the results of 68 LigaSure patients were evaluated. The main outcomes measured were age, sex, operating time, postoperative hypocalcemia, recurrent laryngeal nerve palsy, and drain use. Statistical analysis consisted of the chi-squared test and Student's t-test. The mean operating time was significantly shorter in the LigaSure group by 24.1 +/- 1.7 minutes for a total thyroidectomy (P < 0.0001) and 7.6 +/- 0.1 minutes for one side total plus other side sub- total thyroidectomy (P < 0.0001). Bleeding during surgery was significantly lower in the LigaSure group (P < 0.0001). There were no significant differences between the study groups in terms of postoperative hypoparathyroidism, recurrent laryngeal nerve palsy, and postthyroidectomy hemorrhage. The LigaSure vessel sealer is a safe, effective alternative for thyroid surgery that reduces the overall operating time. However, its higher cost is a significant handicap for its use in surgery in developing countries.