J Endocr Surg.  2019 Dec;19(4):106-115. 10.16956/jes.2019.19.4.106.

A Prospective, Randomized, Controlled Comparative Study of Three Energy Devices in Open Thyroid Surgery: Thunderbeat, Harmonic, and Ligasure

Affiliations
  • 1Division of Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. jskim0126@skku.edu

Abstract

PURPOSE
Energy devices, such as Harmonic Focus Plus (Ethicon; ultrasonic scalpel; Harmonic) and Ligasure Small Jaw (Covidien; bipolar sealer; Ligasure) are widely used in thyroid surgery as substitutes for Bovie (electrocautery) and sutures. They reduce operation time and peri-operative complications. Thunderbeat Open Fine Jaw (Olympus; Thunderbeat) is a recently developed energy device, which combines the functions of both ultrasonic scalpel and bipolar sealer. We prospectively evaluated the safety and feasibility of Thunderbeat during open thyroidectomy compared with Harmonic and Ligasure.
METHODS
From September to November 2016, patients with papillary thyroid cancer or benign thyroid disease who underwent unilateral or bilateral thyroidectomy at Samsung Medical Center were enrolled. Thyroidectomies were performed by a single surgeon who specializes in endocrine surgery and is experienced in using energy devices. The patients were randomly allocated to one of the 3 groups according to the energy device used during the operation: Harmonic, Ligasure, and Thunderbeat group.
RESULTS
No significant differences were detected among the 3 groups in intra-operative bleeding, drainage amount, incidence of transient hypocalcemia, and transient vocal cord palsy. The surgical time for thyroidectomy in the T group was shorter than in the other 2 groups (P=0.031). However, the H group showed reduced surgical time for central lymph node dissection.
CONCLUSION
Among the 3 energy devices, Thunderbeat and Harmonic shortened the surgical time for thyroidectomy and central lymph node dissection, respectively. However, each energy device has its own strengths and weaknesses, and we recommend the selection of devices based on the respective features.

Keyword

Thyroidectomy; Papillary thyroid carcinoma; Medical devices; Device safety; Feasibility studies

MeSH Terms

Drainage
Equipment Safety
Feasibility Studies
Hemorrhage
Humans
Hypocalcemia
Incidence
Jaw
Lymph Node Excision
Operative Time
Prospective Studies*
Sutures
Thyroid Diseases
Thyroid Gland*
Thyroid Neoplasms
Thyroidectomy
Ultrasonics
Vocal Cord Paralysis

Figure

  • Fig. 1 Flow diagram of the study. H group = Harmonic group; L group = Ligasure group; T group = Thunderbeat group.


Cited by  1 articles

Letter to the Editor: A Prospective, Randomized, Controlled Comparative Study of Three Energy Devices in Open Thyroid Surgery: Thunderbeat, Harmonic, and Ligasure
Sabaretnam Mayilvaganan, Mahalakshmi D Vnssvams
J Endocr Surg. 2020;20(1):1-1.    doi: 10.16956/jes.2020.20.1.1.


Reference

1. Fagotti A, Vizzielli G, Fanfani F, Gallotta V, Rossitto C, Costantini B, et al. Randomized study comparing use of THUNDERBEAT technology vs standard electrosurgery during laparoscopic radical hysterectomy and pelvic lymphadenectomy for gynecologic cancer. J Minim Invasive Gynecol. 2014; 21:447–453.
Article
2. Obonna GC, Mishra RK. Differences between Thunderbeat, Ligasure and Harmonic scalpel energy system in minimally invasive surgery. World J Laparos Surg. 2014; 7:41–44.
Article
3. Seehofer D, Mogl M, Boas-Knoop S, Unger J, Schirmeier A, Chopra S, et al. Safety and efficacy of new integrated bipolar and ultrasonic scissors compared to conventional laparoscopic 5-mm sealing and cutting instruments. Surg Endosc. 2012; 26:2541–2549.
Article
4. Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A. AJCC Cancer Staging Manual. 7th ed. New York: Springer;2010.
5. Lang BH, Yih PC, Hung GK. Does using an energized device in open thyroidectomy reduce complications? J Surg Res. 2013; 181:e23–e29.
Article
6. Garas G, Okabayashi K, Ashrafian H, Shetty K, Palazzo F, Tolley N, et al. Which hemostatic device in thyroid surgery? A network meta-analysis of surgical technologies. Thyroid. 2013; 23:1138–1150.
Article
7. Ruggiero R, Gubitosi A, Conzo G, Gili S, Bosco A, Pirozzi R, et al. Sutureless thyroidectomy. Int J Surg. 2014; 12:Suppl 1. S189–S193.
Article
8. Alexiou K, Konstantinidou E, Sikalias N. The use of new energy-based haemostatic methods in thyroid surgery: sutureless total thyroidectomy (ultrasonic coagulation and/or electro thermal bipolar vessel sealing system) versus classic suture ligation (clamp-and-tie) technique. Hell Cheirourgike. 2015; 87:92–96.
9. Teksoz S, Bukey Y, Ozcan M, Arikan AE, Ozyegin A. Sutureless thyroidectomy with energy-based devices: cerrahpasa experience. Updates Surg. 2013; 65:301–307.
Article
10. Kwak HY, Chae BJ, Park YG, Kim SH, Chang EY, Kim EJ, et al. Comparison of surgical outcomes between papillary thyroid cancer patients treated with the Harmonic ACE scalpel and LigaSure Precise instrument during conventional thyroidectomy: a single-blind prospective randomized controlled trial. J Surg Res. 2014; 187:484–489.
Article
11. Dionigi G, Boni L, Rausei S, Frattini F, Ferrari CC, Mangano A, et al. The safety of energy-based devices in open thyroidectomy: a prospective, randomised study comparing the LigaSure™ (LF1212) and the Harmonic® FOCUS. Langenbecks Arch Surg. 2012; 397:817–823.
Article
12. Van Slycke S, Gillardin JP, Van Den Heede K, Minguet J, Vermeersch H, Brusselaers N. Comparison of the Harmonic focus and the Thunderbeat for open thyroidectomy. Langenbecks Arch Surg. 2016; 401:851–859.
Article
13. Smith CT, Zarebczan B, Alhefdhi A, Chen H. Infrared thermographic profiles of vessel sealing devices on thyroid parenchyma. J Surg Res. 2011; 170:64–68.
Article
14. Applewhite MK, White MG, James BC, Abdulrasool L, Kaplan EL, Angelos P, et al. Ultrasonic, bipolar, and integrated energy devices: comparing heat spread in collateral tissues. J Surg Res. 2017; 207:249–254.
Article
15. Kwak HY, Dionigi G, Kim D, Lee HY, Son GS, Lee JB, et al. Thermal injury of the recurrent laryngeal nerve by THUNDERBEAT during thyroid surgery: findings from continuous intraoperative neuromonitoring in a porcine model. J Surg Res. 2016; 200:177–182.
Article
16. Park MW, Baek SK, Park EH, Jung KY. Long-term voice outcome after thyroidectomy using energy based devices. Auris Nasus Larynx. 2018; 45:527–532.
Article
Full Text Links
  • JES
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr