Thyroid surgery: use of ligasure vessel sealing system versus conventional knot tying method

The aim of this study was to compare the use of conventional knot tying vs. LigaSure Vessel Sealing System [Valley lab, Boulder, Colorado] in patients undergoing thyroid surgery. We hypothesized that the use of LigaSure would reduce the time of operation without more complications. This study was conducted in Endocrine Surgery Unit, Mansoura University Hospital on patients who underwent thyroid surgery from January 1, 2006 to December 31, 2006. 110 patients were operated upon by the same team of surgeons using conventional knot tying in 55 and LigaSure in 55 patients for hemostasis. The medical records of patients enrolled regarding age, sex, histopathological diagnosis, type of operation performed [lobectomy vs. subtotal thyroidectomy vs. total thyroidectomy]; the operation time, intraoperative blood loss, postoperative complications, length of incision, hospital stay and cost, as well as the postoperative pain and outcome were reviewed and compared. The two groups had nearly similar demographic data. We have noticed that patients in the LigaSure[TM] group had significant lower operating times [P = 0.000], lower intraoperative blood loss [P = 0.000], less postoperative pain and early pain-free return to normal activity and return to work [P = 0.0001]. LigaSure Vessel Sealing System was as safe as conventional knot tying method for thyroidectomy, with the benefit of a reduced operating time, decreased postoperative pain and early pain-free return to normal activity and return to work

Effect of near-total thyroidectomy on thyroid orbitopathy due to toxic goiter

Background: the relative merit of operation in the treatment of Graves' ophthalmopathy as well as the extent of surgical resection is still a matter of debate. This work aimed at reporting the assessment of the impact of near-total thyroidectomy on the course of ophthalmopathy including exophthalmos

Methods: a total of 20 patients, with phytotoxic goiters suffering from mild to moderate exophthalmos were enrolled onto this prospective study. Preoperative evaluation of ophthalmopathy was accomplished through the NOSPECS classification, MRI Scanning for measuring the extraocular muscle diameters and measurement of the exophthalmos using Hertel's exophthalmometer. Six months postoperatively, ophthalmopathy including exophthalmos was reevaluated using the same parameters mentioned before

Results: clinical activity evaluation, exophthalmometry and extraocular muscles measurement by MRI revealed that the majority of the cases experienced improvement of their ophthalmopathy [65%]. This improvement was statistically significant In addition, no major postoperative complications were observed. However, the study, unlike a number of reported retrospective ones, failed to specify any statistically significant prognostic factors affecting the course of ophthalmopathy possibly due to the limited number of cases in general. In addition, all of the cases were of relatively young age and thyrotoxic, and the majority were females and non-smoking

Conclusion: beside the fact that near-total thyroidectomy adds the advantages of total thyroidectomy [no recurrence] to those of subtotal thyroidectomy [low incidence of temporary and permanent hypoparathyroidism], it has a significant positive impact on thyroid-associated orbitopathy