Comparative outcomes of the CoolSeal Reveal in thyroid surgery

Energy-based hemostatic devices have been adopted by surgeons to provide durable hemostasis in thyroid operations. The CoolSeal® Reveal is the newest of these devices, and literature regarding its comparative efficacy remains sparse. This study compared surgical outcomes of the CoolSeal® Reveal with well-established hemostatic devices commonly employed in thyroid operations. This was a retrospective review of 1219 patients who underwent thyroid resections by a single surgeon from May 2017 to September 2023. Surgical outcomes for the Harmonic® Ultrasonic Scalpel (n = 645), LigaSure™ Small Jaw (n = 185), and CoolSeal® Reveal (n = 389) were evaluated and rates of postoperative complications and operative times for each device were compared. An overall complication rate of 4.2% (n = 51) was observed with no significant differences across devices (p = .818) in terms of postoperative hematoma (p = .163), recurrent laryngeal nerve injury (p = .217), or postoperative hypocalcemia (p > .999). The CoolSeal® demonstrated a lower median operating time of 51 min (p < .0001) and 80 min (p = .001) for lobectomy and total thyroidectomy, respectively, when compared to the Harmonic®. No differences were observed when comparing the CoolSeal® and LigaSure™. The CoolSeal® Reveal appears to demonstrate outcomes that are comparable to the well-studied and time-tested LigaSure™ and Harmonic® devices. Our early experience with the CoolSeal® found it to be a safe and effective alternative to these devices; however, it needs to be studied in greater numbers to corroborate these results.