Comparative analysis between ultrasonic shears versus advanced bipolar device in transoral endoscopic thyroidectomy:...

Area of Science:

• Endocrine Surgery
• Minimally Invasive Surgery
• Surgical Technology

Background:

• Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a novel, scarless minimally invasive thyroidectomy technique.
• Effective energy devices are crucial for dissection and hemostasis in endoscopic thyroid surgery.
• No prior clinical studies have compared ultrasonic shears and advanced bipolar devices specifically for TOETVA.

Purpose of the Study:

• To determine the comparative efficacy of ultrasonic shears versus an advanced bipolar device in TOETVA.
• To evaluate which energy device offers better performance in terms of operative efficiency and safety during TOETVA.

Main Methods:

• An open-label, prospective randomized controlled trial was conducted with 40 patients undergoing TOETVA.
• Patients were randomized into two groups: ultrasonic shears (n=20) or advanced bipolar device (n=20).
• Primary outcomes included lobectomy time, camera cleaning frequency, and blood loss; secondary outcomes assessed pain, drainage, and blood chemistry.

Main Results:

• The advanced bipolar group demonstrated a significantly shorter lobectomy operation time (33.8 vs. 41.9 minutes, P=0.002).
• Fewer camera cleanings were required in the advanced bipolar group (2.9 vs. 5.8 times, P<0.001).
• Estimated blood loss was significantly lower in the advanced bipolar group (11.5 vs. 81.8 mL, P=0.004), with no significant differences in other outcomes.

Conclusions:

• The advanced bipolar device exhibited superior performance in TOETVA, evidenced by reduced operation time, fewer camera cleanings, and less blood loss.
• The findings suggest the advanced bipolar device is a preferable energy source for performing TOETVA.
• Further research may explore long-term outcomes and broader applications of this device in endoscopic thyroid surgery.