Sutureless total thyroidectomy: a safe and cost-effective alternative Ling-Yun Chang, Christine O’Neill, James Suliburk, Stan Sidhu, Leigh Delbridge and Mark Sywak University of Sydney Endocrine Surgical Unit, Australia Key words hypoparathyroidism, post-operative haematoma, recurrent laryngeal nerve, thyroid cancer, thyroidectomy. Abbreviations RLN, recurrent laryngeal nerve. Correspondence Dr Mark Sywak, University of Sydney Endocrine Surgical Unit, Suite 202, 69 Christie St, St. Leonards NSW 2065, Australia. Email: marksywak@nebsc.com.au L-Y Chang MBBS(Hons), BSc(Medical); C. O’Neill MBBS(Hons), FRACS; J. Suliburk MD; S. Sidhu PhD, FRACS; L. Delbridge MD, FRACS; M. Sywak MMED(Clinepi), FRACS. An earlier version of this article was presented in abstract form at the Annual Scientific Congress in Brisbane in May 2009. Accepted for publication March 2010. doi: 10.1111/j.1445-2197.2010.05492.x Abstract Background: Advanced vessel sealing devices provide an alternative to conventional ligation techniques for thyroidectomy. To date, most studies have been inadequately powered to explore differences in the infrequent post-operative complications follow- ing thyroidectomy. This study is designed to compare the outcomes of sutureless thyroidectomy and conventional thyroidectomy for recurrent laryngeal nerve (RLN) injury, permanent hypoparathyroidism, and haematoma formation. Methods: A cohort study of consecutive patients undergoing total thyroidectomy using conventional versus sutureless techniques was performed. Sutureless thyroidec- tomy was performed using either Ligasure Precise (Covidien) or Harmonic Focus (Johnson and Johnson) devices. The primary outcome measures were post-operative haemorrhage, permanent RLN injury and hypoparathyroidism. Secondary outcome measures were operative time, temporary hypoparathyroidism and vocal cord dysfunc- tion. A cost minimization analysis comparing the two techniques was performed. Result: From January 2006 to July 2009, 1935 consecutive patients underwent total thyroidectomy. Of these, 772 underwent conventional thyroidectomy and 1163 were performed using a sutureless technique. The mean operative time was significantly lower in the sutureless group (71 versus 86 min, P = 0.02). There was no difference in the post-operative complications of haematoma (0.78% conventional versus 1.12% sutureless, P = 0.46), permanent hypoparathyroidism (1.30% conventional versus 0.52% sutureless, P = 0.06) or permanent RLN injury (0.26% conventional versus 0.52% sutureless, P = 0.39). There was an overall cost saving of AUD$14 300 per 100 total thyroidectomy cases performed using the sutureless technique. Conclusions: Sutureless thyroidectomy is a safe and efficient way of performing total thyroidectomy and has the potential to reduce operating room costs. Introduction The development of advanced vessel sealing devices for the control of vascular pedicles is replacing traditional techniques for vessel ligation in a wide variety of surgical procedures. 1 Given the exten- sive vascular network of the thyroid gland, thyroidectomy proce- dures are ideally suited for new vessel sealing technologies that have the potential to provide an alternative to traditional ligatures and titanium clips. In the setting of thyroid surgery the two most widely used devices are the Harmonic Focus (Johnson and Johnson, Ethicon Endo-surgery, Cincinnati, OH, USA) and the Ligasure Precise (Covidien, Boulder, CO, USA). Both instruments have been specifi- cally developed for use in thyroid surgery. The Harmonic scalpel uses an active blade which oscillates at 55 kHz, and simultaneously cuts and coagulates vessels. Ligasure is a bipolar diathermy instru- ment which uses a feedback sensor system to signal the completion of coagulation. Both instruments have been shown to reliably control vessels with complication rates that are equivalent to traditional techniques for vessel ligation. 2–4 Sutureless thyroidectomy techniques have been reported to provide benefits in post-operative pain, reduced post-operative seroma formation and lower complication rates in some studies. 1,5,6 The most consistently reported benefit is the significant reduction in operative time with decreases of 20–30% demonstrated in most studies. 2,5,7 Few of the published studies have been adequately powered to compare the outcomes of recurrent laryngeal nerve injury, permanent hypoparathyroidism or post-operative haematoma formation where accepted rates of these complications in experi- enced hands should be less than 1–2%. 4,8,9 This study is designed to compare the early outcomes of sutureless thyroidectomy in a large ENDOCRINE SURGERY ANZJSurg.com © 2010 The Authors ANZ Journal of Surgery © 2010 Royal Australasian College of Surgeons ANZ J Surg 81 (2011) 510–514