Objective To compare the advantages and disadvantages of using the harmonic scalpel and bipolar coagulation forceps versus harmonic scalpel and conventional clamp-and-tie technique in open thyroid surgery.Methods One hundred patients indicated for thyroid surgery were randomly divided into two groups：the bipolar coagulation forceps group underwent surgery with harmonic scalpel and bipolar coagulation forceps，and the conventional clamp-and-tie group with harmonic scalpel and conventional clamp-and-tie technique，respectively.All operations were performed by the same group of doctors.The total operation time，intraoperative bleeding，mass diameter，postoperative drainage，and surgical complications （postoperative bleeding， postoperative recurrent laryngeal nerve paralysis，seroma，and permanent postoperative hypoparathyroidism） were compared.Results There were 48 valid cases in the bipolar coagulation forceps group， and 49 cases in the conventional clamp-and-tie group. There were no significant differences between two groups patients of age，gender，disease composition，and mass diameter（P＞0.05）.With the same operative approach， the total operation time，intraoperative bleeding，and the incidence of transient postoperative hypoparathyroidism in the bipolar coagulation forceps group were significantly lower than those in the conventional clamp-and-tie group （P＜0.001）.The postoperative drainage in the bipolar coagulation forceps group was more than that in the conventional clamp-and-tie group （P＜0.05）.There was no single case of postoperative bleeding，postoperative recurrent laryngeal nerve paralysis，seroma，and permanent postoperative hypoparathyroidism in both groups.Conclusions The combination of harmonic scapel with bipolar coagulation forceps provides significant advantages over the combination of harmonic scapel with conventional clamp-and-tie technique in open thyroid surgery.
ObjectiveTo summarize the new ideas and new instruments in thyroid surgery. MethodsRelated literatures were reviewed and analyzed. ResultsTotal thyroidectomy had become the preferred option for differentiated thyroid cancer and multiple nodule goiter. The key change of surgery was from recurrent laryngeal nerve-protection to parathyroid-protection. Harmonic scalpel, bipolar coagulation forceps and Ligasure were used to thyroid surgery, which could shorten operation time and reduce operative bleeding. ConclusionThe ideas and techniques of thyroid surgery have changed, total thyroidectomy and parathyroid protection are being paid more and more attentions, and new instruments are used more extensively in thyroid surgery.
ObjectiveTo explore the feasibility and safety of clinical application of bipolar coagulation forceps in open thyroid operations and summarize the operation skill. MethodsThe clinical data of 347 cases performed thyroid operations with bipolar coagulation forceps and Harmonic scalpel respectively from October 2010 to October 2014 in our hospital were analyzed retrospectively. ResultsNo statistical differences was found on the operative time, intraoperative bleeding, postoperative drainage, and postoperative hospitalization of the two groups (P > 0.05). The complications of transient palsy of recurrent laryngeal nerve and transient functional insufficiency of parathyroid were more in Harmonic scalpel group than in bipolar coagulation forceps group with statistical difference (P < 0.05). But there was no difference of the complications of airway obstruction, permanent injuries of recurrent laryngeal nerve, parathyroid and superior laryngeal nerve in the two groups (P > 0.05). ConclusionsThyroid operations with bipolar coagulation forceps are safe and feasible. Coagulation tightly along the thyroid capsule followed by incision with explicit subtle dissection is the key point of the decrease of complications.
Objective To assess clinical value of thyroidectomy by meticulous capsular dissection technique through neck incision approach in treatment of 75 patients with type Ⅰ substernal goiter. Methods The clinical data of 75 patients with type Ⅰ substernal goiter in the Department of General Surgery of the Central Hospital of Xiaogan from April 2013 to April 2017 were retrospectively analyzed. These patients received the surgical resection by the meticulous capsular dissection technique with an ultrasonic scalpel and a bipolar coagulation forcep through neck incision approach. Results There were 12 Hashimoto thyroiditis, 10 thyroid adenoma, 41 nodular goiter, and 12 thyroid carcinoma in the 75 patients with type Ⅰ substernal goiter. Five cases underwent the unilateral total thyroidectomy. Fifty-eight cases underwent the bilateral total thyroidectomy. The bilateral total thyroidectomy plus central lymph node dissection were performed in the 9 patients with thyroid carcinoma, the bilateral total thyroidectomy plus central lymph node dissection plus affected ipsilateral neck lymph node dissection were performed in the 3 patients with thyroid carcinoma. The average operative time was 100 min, the average intraoperative blood loss was 50 mL, the average postoperative hospital stay was 5 d. The rate of parathyroid injury was 2.7% (2/75), the rate of hypocalcemia caused by parathyroid injury was 2.7% (2/75). There were 3 cases (4.0%) of unilateral recurrent laryngeal nerve injury, 1 case (1.3%) of the outer branch of the upper laryngeal nerve injury. There were 2 cases of tracheal partial softening in the 75 patients. None of postoperative bleeding and seroma happened. No death and the tumor recurrence and metastasis of patients happened during follow-up period. Conclusions Preliminary results in this study show that operation of meticulous capsular dissection technique with an ultrasonic scalpel and a bipolar coagulation forcep through neck incision approach in treatment of type Ⅰ substernal goiter is safe and feasible, it could effectively reduce postoperative complications of thyroidectomy, and protect parathyroid and it’s function, recurrent laryngeal nerve, and superior laryngeal nerve.