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December 21, 2009

Prospective Clinical Trials of Thyroidectomy With LigaSure vs Conventional Vessel Ligation: A Systematic Review and Meta-analysis

Author Affiliations

Author Affiliations: Department of General Surgery, Shanghai Chang Zheng Hospital, Second Military Medical University, Shanghai, China.

Arch Surg. 2009;144(12):1167-1174. doi:10.1001/archsurg.2009.201

Objective  To evaluate the hemostatic effects and safety of thyroidectomy performed using the LigaSure vessel-sealing device (Valleylab, Boulder, Colorado) or the conventional vessel ligation.

Data Sources  The MEDLINE, EMBASE, Elsevier, SpringerLink, Ovid, and Cochrane Library electronic databases as well as the LigaSure manufacturer's Web site were searched for studies published between 1996 and 2008. No language restrictions were applied.

Study Selection  Prospective, controlled clinical trials, both randomized and nonrandomized, comparing the hemostatic effects and safety of thyroidectomy using LigaSure and conventional vessel ligation were selected.

Data Extraction  Data regarding operative parameters, duration of the operation, amount of intraoperative blood loss, length of hospital stay, and any postoperative complications were entered and analyzed using dedicated software from the Cochrane Collaboration.

Data Synthesis  Four randomized and 5 nonrandomized trials that met selection criteria reported data from 927 patients, of whom 467 (50.4%) underwent LigaSure and 460 (49.6%) underwent conventional thyroidectomy. Operative duration (weighted mean difference [WMD], –11.97 minutes; 95% confidence interval [CI], –16.42 to –7.53 minutes) was significantly reduced with LigaSure thyroidectomy (P < .001). When LigaSure was used, operative time reductions of 20.32 minutes (95% CI, –33.86 to –6.79 minutes) for total thyroidectomy (P = .003) and 21.74 minutes (–38.32 to –5.16 minutes) for subtotal thyroidectomy (P = .01) were also confirmed with subgroup analysis. However, differences in the amount of intraoperative blood loss (WMD, –25.13 mL; 95% CI, –68.45 to 18.18 mL; P = .26), length of hospital stay (WMD, –0.08 days; 95% CI, –0.23 to 0.08 days; P = .31), and postoperative complication rates (odds ratio, 0.91; 95% CI, 0.61-1.04; P = .65) were not statistically significant for LigaSure vs conventional thyroidectomy.

Conclusions  The LigaSure technique may provide a safe, effective, and fast alternative to conventional vessel ligation in thyroidectomy and may result in a significant reduction in operative duration. However, it may not confer any advantage over conventional thyroidectomy in terms of the amount of intraoperative blood loss, length of hospital stay, and postoperative complication rates.