ELECTROTHERMAL BIPOLAR VESSEL SEALING SYSTEM IS A SAFE AND TIME-SAVING ALTERNATIVE TO CLASSIC SUTURE LIGATION IN TOTAL THYROIDECTOMY Andreas Manouras, MD, PhD, Emmanuel E. Lagoudianakis, MD, Pantelis T. Antonakis, MD, George M. Filippakis, MD, Haridimos Markogiannakis, MD, Panagiotis B. Kekis, MD First Department of Propaedeutic Surgery, Hippocrateion Hospital, Athens Medical School, Q. Sophia114, 11527, Athens, Greece. E-mail: amanouras@hippocratio.gr Accepted 16 April 2005 Published online 30 August 2005 in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/hed.20271 Abstract: Background. Total thyroidectomy is associated with minimal morbidity. The electrothermal bipolar vessel sealing system is an adjunct to the surgical technique, recently made available to thyroid surgery. Methods. This is a prospective randomized trial of total thyroidectomies performed in single unit from July 2003 to May 2004. Patients were randomly assigned in two groups: group A (n = 90), total thyroidectomy with the classic suture ligation technique; and group B (n = 94), total thyroidectomy with the use of the electrothermal bipolar vessel sealing system. Results. Operative time was significantly reduced in group B by 14 minutes (mean difference, 14.3 F 4.2 minutes, 95% CI, 5.88 – 22.6 minutes). No statistically significant differences were found in postoperative complications, postoperative serum cal- cium measurements, or hospital stay between the two groups. Conclusions. The electrothermal bipolar vessel sealing system is a safe and useful, time-saving adjunct for total thyroidectomy. A 2005 Wiley Periodicals, Inc. Head Neck 27: 959 – 962, 2005 Keywords: total thyroidectomy; LigaSure; hemostasis; ligation Thyroid surgery in the 21st century has become safe and effective with improved outcome and minimal complications. Total thyroidectomy, after a period of 25 years of major evolution, has become the standard procedure for patients with malignant thyroid tumors, bilateral multinodular goiter, and Graves’ disease. 1,2 The importance of safe operative technique is emphasized because use of gentle and skillful maneuvers is essential for safe dissection of the gland, avoiding damage to the delicate and important adjacent structures. Thyroidectomy demands a great amount of clamp-and-tie maneuvers for ligation of the named and numerous smaller thyroid vessels. A blood-stained operative field makes troublesome the recognition and safe dissection of the recur- rent laryngeal nerve and parathyroid glands, and efforts to control bleeding from retracted thy- roid vessels increase the risk of damage to adja- cent structures. Current methods for hemostasis are ligations, sutures, metallic clips, staples, and coagulation devices. Ligation and sutures are time consum- ing, and nonabsorbable materials, such as suture Correspondence to: A. Manouras B 2005 Wiley Periodicals, Inc. Electrothermal Bipolar Vessel Sealing System HEAD & NECK November 2005 959