Comparison between ligasure vs. clamp-and-tie technique in total thyroidectomy for benign multilnodular goiter. A prospective randomized study

Introduction: LigcaSure [Valley Lab, 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 haemostasis 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

Methods: 60 patients underwent total thyroidectomy [30 with the conventional clamp-and-tie technique and 30 with LigaSure]. The main outcomes measured were age, sex, operating time, postoperative hypocalcaemia, recurrent laryngeal and nerve palsy, statistical analysis consisted of the chi-squared test and Student's t-test

Results: The mean operating time was significantly shorter in the LigaSure group [115.00 +/- 13.20 vs 88.83 +/- 11. 50 minutes; P=0.00]. Bleeding during surgery was significantly lower in the LigaSure group [118 +/- 15.33 ml vs. 69. 17:11:15 ml P=0.0]. There were no significant differences between the study groups in terms of postoperative hypo-parathyroidism or recurrent laryngeal nerve palsy

Conclusion: The LigciSure vessel sealer is a safe, effective alternative for thyroid surgery that reduces the overall operating time and operative blood loss, however, its higher cost is a significant limiting factor for its use in surgery

Presentation and clinical outcome of patients with malignant salivary gland tumors

Salivary gland cancer is a rare disease and comprises approximately 5 to 6% of cancers of the head and neck and 0.3% of all cancers. These tumors display a diverse biological behaviors and clinical presentation. Currently, many series has described site, size stage, histology and grade of the tumors as important prognostic factors affecting the outcome. Aim of the work was to evaluate the presentation and management outcome of patients presented with salivary gland cancer in search of prognostic factors for locoregionl control, disease free survival, and overall survival. The records of all patients with malignant salivary gland tumors presenting for treatment at our institution between October 1997 and October 2002 were reviewed. Variables were collected and outcome measures were defined in terms of locoregional, and distant control, and overall survival and disease-free survival [DFS], in 5 years follow up. Survival was described using the Kaplan-Meier method. This study included 46 patients [24 males and 22 females] ranging in age from 22 to 86 years with mean age of 53 +/- 18 years. The disease-free survival and overall survival rate were 65.5% and 69.5%, at 5 years, respectively. We found that survival was significantly better in younger patients [P = 0.05], male patients [P = 0.001] early stage [P = 0.001], patients with parotid cancer [P = 0.004], low/intermediate grade [P = 0.0006] and patients who received postoperative adjuvant radiation [P = 0.003]. The majority of our patients presented in advanced stage, which necessitated aggressive surgical treatment. Postoperative adjunctive radiotherapy seems to play an important role in those patients. However, the benefits of combined modality therapy await prospective clinical trials. This study confirmed the contributions of age, sex, site, stage, and grade for locoregional control and survival