ABSTRACT
OBJECTIVE: The aim of the study was to compare the efficiency, safety, and cost of the different methods of hemostasis (conventional hemostasis versus LigaSure vessel sealing system [LVSS] versus harmonic scalpel) currently available for thyroid surgery. STUDY DESIGN: Randomized, controlled trial. SETTING: The study was conducted from September 2007 to December 2008 in a university hospital. PATIENTS AND METHODS: Sixty patients (48 females and 12 males) underwent a total thyroidectomy for multinodular goiter. They were randomly assigned into three groups: group one (n = 20), conventional hemostasis; group two (n = 20), LigaSure; and group three (n = 20), harmonic scalpel. RESULTS: For group three, the mean operative time was 37 minutes shorter than group one (P < 0.001) and eight minutes shorter than group two (P = 0.04). The complications rate was similar among the three groups. The mean postoperative paracetamol consummation in group one was 1.4 g greater than in group two (P = 0.016) and 1.3 g greater than in group three (P = 0.02). The overall average operative cost was 11 and 85 dollars cheaper for groups two and three than for group one, respectively (P < 0.001). CONCLUSION: Total thyroidectomy using the harmonic scalpel was the fastest procedure because it was bloodless, and hemostasis and sectioning were controlled with a single instrument; it was, therefore, the most inexpensive procedure because of the reduction of operative time and staff cost. The operative safety was similar for all three procedures. In our series, the harmonic scalpel and the LVSS caused less pain than the conventional hemostasis.
Subject(s)
Hemostasis, Surgical/instrumentation , Hemostasis, Surgical/methods , Surgical Instruments , Thyroidectomy , Blood Loss, Surgical , Costs and Cost Analysis , Drainage , Electrocoagulation , Female , Hemostasis, Surgical/economics , Humans , Male , Middle Aged , Postoperative Complications , UltrasonicsABSTRACT
OBJECTIVE: To evaluate the complications related to implantation and use of totally implantable venous access devices (TIVAD). METHODS: Retrospective study based on 116 TIVAD involving 113 adult patients (93M/20F, mean age 59 years). The implantation was achieved under local anaesthesia (69% of cases) and under general anaesthesia (31% of cases). RESULTS: The total TIVAD follow-up time was of 45 963 days (mean per device: 396 days). We used cephalic vein (95 cases), subclavian vein (13), internal jugular vein (4) and external jugular vein (4). A total of 27 complications were observed: 2 were related to the implantation (1 haematoma, 1 wrong positioning of the catheter), 25 were due to the use of the device, among which: 10 septicaemias (0.22/1 000 catheter days), 6 deep vein thrombosis (0.13/1 000 catheter days), 4 catheter obliterations (0.09/1 000 catheter days), one local infection (0.02/1 000 catheter days) and 4 catheter disconnections (0.09/1 000 catheter days) including 3 intra-cardiac migrations due to a defective model. These complications led to early removal of 14% of devices. The side of implantation and the type of venous access had no statistically significant incidence on postoperative complications. Operative accidents were avoided by the predominant use of venous access by dissection rather than by puncture. CONCLUSION: The complications described were considerable, notably during the intensive use of TIVAD. However they must not mask the benefits of such devices. They justify the training of medical staff and the development of preventive measures.
