US Evaluation of Topical Hemostatic Agents in Post-Thyroidectomy

Area of Science:

• Surgical Innovation
• Medical Imaging
• Biomaterials

Background:

• Topical hemostatics are frequently used during thyroidectomy to control bleeding.
• Post-operative ultrasound surveillance is crucial for monitoring thyroidectomy patients.
• The ultrasound appearance of these hemostatic agents can mimic native tissue or pathology.

Purpose of the Study:

• To characterize the B-mode ultrasound appearance of two common topical hemostatics used in thyroid surgery.
• To differentiate between hemostatic material, native thyroid tissue, and potential cancer recurrence on ultrasound.
• To provide guidance for accurate interpretation of post-thyroidectomy ultrasound findings.

Main Methods:

• Prospective study involving 84 patients undergoing thyroidectomy.
• Comparison of two topical hemostats: oxidized regenerated cellulose (Oxitamp®) and fibrin glue (Tisseel®).
• B-mode ultrasound examinations were performed to assess hemostatic residue.

Main Results:

• Hemostatic residue from oxidized regenerated cellulose (Oxitamp®) was detected in approximately 80% of patients, potentially mimicking native tissue or recurrence.
• No residue was observed with fibrin glue hemostats (Tisseel®).
• Oxidized cellulose-based hemostats showed prolonged presence, exceeding manufacturer's resorption claims, and required specific recognition patterns to avoid misdiagnosis.

Conclusions:

• Fibrin glue hemostats offer advantages in ultrasound follow-up due to minimal residual impact.
• Understanding the ultrasound characteristics of oxidized cellulose-based hemostats is essential for reducing diagnostic errors and unnecessary investigations.
• Accurate identification of hemostatic material prevents misinterpretation as native gland or tumor recurrence.