Reassessing Bipolar Cautery in Thyroidectomy: An Affordable Alternative to Advanced Energy Devices in Resource-Poor...

Introduction Thyroidectomy is one of the most commonly performed surgeries around the world. Historically, it was a high-mortality procedure. However, this is not the case today due to advances in surgical technique and instruments.  In particular, advanced energy devices such as LigaSure™ (Medtronic, Minneapolis, MN, USA) and Harmonic scalpel (Ethicon, Raritan, NJ, USA) have revolutionised thyroid surgery by enhancing precision and minimising blood loss. These devices are indispensable in most settings. However, in many low- and middle-income countries (LMICs), their high cost and limited availability pose significant barriers to their widespread adoption. Standard bipolar forceps, on the other hand, is widely available in many LMIC settings and is significantly cheaper. In this study, we investigate the safety profile of using standard bipolar forceps in thyroid surgery. This study aimed to investigate the rates of the two most common complications post-thyroidectomy, namely, hypocalcaemia and recurrent laryngeal nerve (RLN) injury.  Methods  A prospective observational study of 178 patients undergoing total thyroidectomy for multinodular goitre was conducted at a single centre in Kerala, India. Postoperatively, all patients were evaluated for hypocalcaemia and RLN injury at six hours and then monthly for six months. Complications persisting at six months were deemed permanent. Any symptoms that resolved before six months were classified as temporary. Results The mean age was 40.8 years, 84/178 patients had symptoms lasting more than a year, and 156/178 patients had at least one nodule measuring ≥3 cm. Out of 178 patients, 118 were female and 60 were male. Around 18.5% (33/178) of patients developed temporary hypocalcaemia. However, only one patient had permanent hypocalcaemia.  About 5.1% (9/178) of patients developed temporary RLN injury, and none of the patients had permanent RLN injury. One patient developed a wound infection, and the mortality rate was 0%. Conclusion  This study outlines the outcomes of employing bipolar forceps for thyroid surgery, highlighting its potential as a safe and cost-effective substitute for advanced energy devices in low-resource settings.