The use of Ultrasonic Dissector in the Prevention of Risk in Thyroid Surgery

Aim: The execution of a correct hemostasis in thyroid surgery is extremely important both for the recognition of the delicate anatomical structures surrounding the thyroid, and to avoid damage of the same with haemostatic maneuvers incongruous. The ultrasonic dissector, developed in ’90s, allows for adequate hemostasis of caliber vessels of diameter up to 3mm, and at the same time has a minimum heat dispersion on the surrounding tissues could be used with the necessary precautions in close proximity to vital structures. We present our experience using the ultrasonic dissector in thyroid surgery. Materials and Methods: It was carried out a retrospective study of patients operated on thyroid from March 2008 to March 2012. Patients were divided into two groups based on the hemostatic technique used: in the conventional technique we used titanium clips, ties and pliers bipolar; in ultrasound technique we have given preference to the ultrasonic dissector but have been used sporadically ligatures and bipolar forceps. It was assessed the duration, the average length of hospitalization, the occurrence of complications and the amount of blood present in the drainage. Results: From 2008 to 2012 underwent thyroid surgery 148 patients. They were 29 men and 119 women of average age 52 aa (range 22-82). They were performed lobectomy 38 and 110 total thyroidectomy. There were 28 cancers, of which 1 in Hashimoto, Graves 5, 7 hyper functioning adenomas and 107 multinodular goiters. The patients were treated with conventional hemostasis in 64 cases and with the aid of the ultrasonic dissector in 84 cases. The operative time was significantly shorter in patients treated with the ultrasonic dissector (106±23 vs. 148±34 min). The postoperative complications were similar in both groups: we had a total of 4 single-sided momentary paralysis of the recurrent nerve, 1 final. There were two cases of permanent hypocalcemia, one for each group, however, we had a momentary hypocalcemia in 11% (7) of patients treated with Ultracision and in 29.7% (25) of patients treated with conventional therapy. The duration of hospitalization was similar in both groups (1.5±2 days). In the group treated with dissector there was a minor oozing serum sanguineous (45±27 vs. 54±51 mL) although that group has manifested a case of severe bleeding (400 ml) which did not require reoperation. Conclusions: The Ultracision has proven to be a valuable aid in thyroid surgery. Although the data are insufficient to enable a final decision certainly this tool is proved to have resulted in a reduction in the intervention of the complications of thyroidectomy reducing surgical time and bleeding risk.