Deykalo, Shidlovsky, Bodnar, and Bodnar: Application of LigaSure Technology in Thyroid Surgery



Problem statement and analysis of the recent research

The incidence of nodular forms of goitre, compression syndrome in particular, as well as thyroid oncopathology is steadily growing. The number of patients with diffuse toxic goitre and functional autonomy of nodular forms of goitre exhibits no tendency toward reduction. Thyroid surgery remains one of the major and most effective methods of treatment.

In the literature, there are no clearly determined indications to the application of the LigaSure technology in thyroid surgery. There are general provisions for its application [2, 4], in particular for surgery in a dry operative field. The risk of intraoperative and postoperative bleeding in thyroid surgery reaches 25% [1]. Damage to the branches of the recurrent nerveand parathyroid glands is often observed [3]. It determines the urgency of clinical and experimental substantiation of applying new technologies in treatment of nodular disease of the thyroid gland. These questions are the aspects our research deals with. Morphological study of the possibility of the surrounding tissues to compensate as well as systemization of complications and efficacy of homeostasis manifestations is equally important. The clarification of these issues will provide us with both thorough interpretations of theoretical regulations for predicting the postoperative period as well as substantiation of safe methods of surgical intervention.

The objective of the research was to assess the efficacy of the LigaSure technology in the formation of reliable homeostasis as well as to provide morphological basis for blood clot quality and morphofunctional state of the thyroid parenchyma after hemithyroidectomy.

Materials and methods

The results of surgical treatment of 100 patients with nodular and toxic forms of goitre being treated in the surgical department of the Ternopil Municipal Emergency Hospital during 2011-2012 (Group II) were compared with the results of surgical treatment of 200 patients with similar pathology who underwent surgical treatment during 2014-2016 (Group I). According to the in-patientmedical records, in patients operated on during 2011-2012 to achieve homeostasis the traditional ligature method was used; the length of surgical access was 6-8 cm. However, to achieve homeostasis in patients operated on during 2014-2016 the LigaSure device was used during surgery; the length of surgical access was 2.5-3 cm. The removed part of the thyroid gland was sent for morphological examination. The thyroid tissue was fixed in a 10% neutral formalin solution to be studied macro-and microscopically. A 1.0x0.5-cm fragment of the thyroid tissue was dissected out from three areas: the first fragment was dissected out from the area of the impact of radio-frequency current; the second fragment was dissected out in the perifocal area 0.5 cm from the electrocoagulation area, and the third one was dissected out 0.8-1.0 cm from the electrocoagulation area. Dewaxed sections were stained with haematoxylin, eosin as well as with Hart and Mallory’s fuchselin. Histological preparations were studied using the SEOSCAN and Lumam P-8 microscopes at different magnifications.

Strict adherence to safety regulations, human dignity and ethical principles in accordance with basic provisions of GSP (1996), UC Convention on Human Rights and Biomedicine (04.04.1997), Helsinki Declaration of the World Medical Association on the ethical principles of scientific medical research involving human subjects (1964-2000), as well as the Order of the Ministry of Health of Ukraine No 281 (01.11.2000) and Code of ethics for a scientist in Ukraine (2009) was provided that was approved by the Bioethics Commission of I. Horbachevsky Ternopil State Medical University (record No 27, 03.02.2014).

Results and Discussion

Table 1 shows the data of the comparative analysis of surgical treatment of two groups of patients with nodular pathology of the thyroid gland who underwent hemithyroidectomy.

Table 1

Results of surgical treatment of patients with nodular and multimodal goitre who underwent hemithyroidectomy

Groups of patients Incision size Duration of surgery Operative blood loss Specific complications Number of postoperative bed days
Group II 6-7 сm 105±7 min 114±2 ml no 6 days
Group I 2.5 -3 сm 68±7 min 78±3 ml no 4.1±0.1 days

Table 2 shows the data of the comparative analysis of surgical treatment of patients with nodular pathology of the thyroid gland who underwent thyroidectomy.

Table 2

Results of surgical treatment of patients with nodular goitre who underwent thyroidectomy

Groups of patients Incision size Duration of surgery Operative blood loss Specific complications Number of postoperative bed days
Group II 6-7 cm 153±6 min 156±4 ml transitory hypoparathyreosis (1) 5.3±0.1 days
Group I 2.5-3 cm 95±2 min 101±3 ml no 4.1±0.1 days

Table 3 shows the data of the comparative analysis of surgical treatment of patients with diffuse toxic goitre (DTG) and mixed toxic goitre (MTG) who underwent thyroidectomy.

Table 3

Results of surgical treatment of patients with DTG and MTG in both groups

Groups of patients Incision size Duration of surgery Operative blood loss Specific complications Number of postoperative bed days
Group II 6-7 сm 172±15 min 375±10 ml tense hematoma (2) 9±0.1 days
Group I 2.5-3 сm 112±11min 222±15 ml no 6±0.1 days

Table 4 shows the data of the comparative analysis of surgical treatment of patients with nodular toxic goitre (NTG) who underwent hemithyroidectomy.

Table 4

Results of surgical treatment of patients with NTG in both groups

Groups of patients Incision size Duration of surgery Operative blood loss Specific complications Number of postoperative bed days
Group II 6-7 сm 215±15 min 391±30 ml laryngotracheitis (4) 9±0.1 days
Group I 2.5-3 сm 83±5 min 58±7 ml no 6±0.1 days

Thus, the application of the LigaSure technology in surgical treatment of the thyroid gland improves the quality of surgical intervention due to a decrease in intraoperative blood loss, duration of surgery as well as postoperative in-patient treatment and minimizes the risk of specific postoperative complications. In addition, the LigaSure technology provides better surgical access, thereby improving cosmetic effect.

The efficacy of the LigaSure technology in the formation of reliable homeostasis that on the basis of our research received morphological confirmation as well as minimal effect of radio-frequency current on the morphofunctional state of the thyroid parenchyma after hemithyroidectomy is equally important.

In the lumen of intraorganic blood vessels, there was formed homogeneous agglutinative thrombus tightly adhering to the vascular wall indicating the formation of reliable and high-quality homeostasis in the area of direct effect of radio-frequency current (Fig.1).

Fig. 1

Agglutinative thrombus in the lumen of intraorganic blood vessel

gmj-23-gmj.2016.3.34-g1.jpg

Morphologic changes in the thyroid gland due to the effect of radio-frequency current were distance-dependent: in the area of direct effect of radio-frequency current coagulative necrosis developed; in the perifocal area intensified secretory response of the thyroid tissue to the extreme factor occurred (Fig. 2); in distant areas the typical structure of the nodular goitre with the signs of disturbed microcirculation was found (Fig. 3).

Fig. 2

Increase in secretory activity of the thyroid tissue

gmj-23-gmj.2016.3.34-g2.jpg
Fig. 3

Oedema of the connective tissue. Vascular thrombosis

gmj-23-gmj.2016.3.34-g3.jpg

Conclusions

  1. The LigaSure technology may be considered as a reliable, safe and morphologically confirmed method of haemostasis in surgical treatment of thyroid pathology.

  2. The LigaSure technology has almost no contraindications except those generally applicable to electrosurgical methods.

  3. In comparison with the other methods of haemostasis, the LigaSure technology is advantageous due to a decrease in duration of surgery and intraoperative blood loss as well as the absence of postoperative complications, shortened period of in-patient treatment and reduced length of surgical access.

References

1 

OS Lareen. Analysis of the endocrinology service of Ukraine in 2010 and prospects for the development of care for patients with endocrine disorders. International Journal of Endocrinology. 2011 Nov;35(3):10-18.

2 

SJ Rebacov, VO Shidlovskij, IV Komisarenko, MP Pavlovskij. Thyroid surgery. Ternopil: TSMU; 2008. 424 p.

3 

YM Taraschenko, IR Janchij, MY Bolgov. Predicting long-term results of surgical treatment of benign focal thyroid disease. International Journal of Endocrinology. 2012;(8):62-65.

4 

SM Cherenko. The basic principles of management of patients who have surgery on the thyroid gland. Health Ukraine. 2012;(2-3):58-60.



Copyright (c) 2017 I. M. Deykalo, O. V. Shidlovsky, Ya. Ya. Bodnar, T. V. Bodnar

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