New ultrasonic dissector versus conventional hemostasis in thyroid surgery: a randomized prospective study

Area of Science:

• Surgical Technology
• Minimally Invasive Surgery
• Thyroid Surgery

Background:

• Ultrasonic dissectors (UD) offer precise tissue coagulation and cutting with minimal thermal damage, advantageous for thyroid surgery.
• A novel ultrasonic dissector (NUD) with a tip <5mm aims for enhanced precision near critical structures like parathyroid glands and the recurrent laryngeal nerve.
• Evaluating the NUD's efficacy and safety in thyroid surgery necessitated a prospective randomized study comparing it to traditional techniques.

Purpose of the Study:

• To assess the effectiveness and safety of a new ultrasonic dissector (NUD) in thyroid surgical procedures.
• To compare operative time, complications, and patient outcomes between the NUD and conventional hemostasis (CH) methods.
• To determine if the NUD can reduce the incidence of hypoparathyroidism and recurrent laryngeal nerve injury during thyroidectomy.

Main Methods:

• A prospective randomized study involving 261 patients undergoing thyroid surgery.
• Patients were allocated to either the new ultrasonic dissector (NUD) group (130 patients) or the conventional hemostasis (CH) group (131 patients).
• Key metrics compared included operative time, postoperative drainage, and complication rates (hypoparathyroidism, recurrent laryngeal nerve damage, pain).

Main Results:

• The NUD group demonstrated significantly shorter operative times for both lobectomy (70±21 vs. 99±27 min) and total thyroidectomy (91±37 vs. 121±42 min).
• Incidence of transient and definitive hypoparathyroidism was significantly lower in the NUD group compared to the CH group (P=.01 for both).
• Transient recurrent laryngeal nerve damage occurred less frequently in the NUD group (5.3%) versus the CH group (9.8%, P=.01), with no significant difference in definitive nerve damage or pain.

Conclusions:

• The new ultrasonic dissector (NUD) may lead to reduced operative times in thyroid surgery.
• NUD utilization is associated with a lower rate of transient and definitive hypocalcemia and transient recurrent laryngeal nerve damage.
• The NUD presents a potentially safer and more efficient alternative for thyroid dissection near vital structures.