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Invited Critique
February 1, 2007

LigaSure vs Clamp-and-Tie Technique to Achieve Hemostasis in Total Thyroidectomy for Benign Multinodular Goiter—Invited Critique

Arch Surg. 2007;142(2):157. doi:10.1001/archsurg.142.2.157

In 1909, Theodor Kocher received the Nobel Prize for his contributions to thyroid surgery. By emphasizing a thorough knowledge of anatomy and meticulous surgical technique, he was able to reduce the mortality of thyroid surgery from more than 13% to 1%.1 His bloodless approach was popularized in America by Halsted.2 Thompson et al3 refined these techniques by ligating individual vessels as they enter the gland and routinely visualizing the parathyroid glands and the recurrent laryngeal nerves. This has decreased the rate of permanent postoperative hypoparathyroidism from 15% to 0.45%, and of recurrent laryngeal nerve injury from 25% to 2.7%.4

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