Postoperative Hypocalcaemia Following Open Thyroidectomy for Benign Multinodular Goiters Using FOCUS Harmonic Scalpel Versus Conventional Suture Ligation Technique for Hemostasis: a Prospective, Single-blind, Randomized Controlled Trial

Sadaf Zehra; Sughra Parveen

doi:10.16956/jes.2018.18.2.132

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Zehra and Parveen: Postoperative Hypocalcaemia Following Open Thyroidectomy for Benign Multinodular Goiters Using FOCUS Harmonic Scalpel Versus Conventional Suture Ligation Technique for Hemostasis: a Prospective, Single-blind, Randomized Controlled Trial

Original Article

J Endocr Surg. 2018;18(2):132-141.

Published online: 5 June 2018

DOI: https://doi.org/10.16956/jes.2018.18.2.132

Postoperative Hypocalcaemia Following Open Thyroidectomy for Benign Multinodular Goiters Using FOCUS Harmonic Scalpel Versus Conventional Suture Ligation Technique for Hemostasis: a Prospective, Single-blind, Randomized Controlled Trial

Sadaf Zehra¹, Sughra Parveen²

¹Department of Surgery, Macclesfield General Hospital, Macclesfield, UK

²Department of Surgery, Jinnah Postgraduate Medical Centre, Karachi, Pakistan

Correspondence to Sadaf Zehra Department of Surgery, Macclesfield General Hospital, 25, Ingersley Building, West Park Drive, SK10, 3FT, Macclesfield, UK. E-mail: sadafnaqvi40@gmail.com

Received 29 December 201710 February 2018 Accepted 11 February 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

초록

Purpose

Vessel hemostasis during thyroidectomy reduces the risk of postoperative hypocalcaemia and is achieved using several techniques. The aim of this study was to compare the occurrence of hypocalcaemia 24-48 hours following total thyroidectomy using FOCUS harmonic scalpel (HS) versus conventional suture ligation (CSL).

Methods

A prospective, single-blind, randomized trial in which 76 patients with benign multinodular goiters were randomized into two groups to receive total thyroidectomy using HS (n=38) or CSL (n=38) techniques. Patients were monitored for hypocalcaemia at 24 and 48 hours post- thyroidectomy and their length of postoperative hospital stay was recorded. Statistical analysis was performed using Student's t-test using SPSS to detect significant differences between groups.

Results

The incidence of postoperative hypocalcaemia was 15.79% in the HS group, and 36.84%, in the CSL group (p =0.033). The number of in situ parathyroid glands was significantly associated with hypocalcaemia in the CSL group (P=0.019), but not in the HS group (P=0.372). Length of hospital stay was 2.63±0.85 in the CSL group and 1.37±0.67 days in the HS group (P<0.001).

Conclusion

Compared to conventional hemostasis, FOCUS HS reduces the overall risk of hypocalcaemia during thyroidectomy for benign thyroid disease. The conventional suture ligation technique should be replaced with FOCUS HS technique for thyroidectomy.

Keywords: Goiters, Thyroidectomy, Hypocalcemia, Parathyroid glands, Hemostasis, Scalpel, Suture, Ligation

REFERENCES

1.Ferri E., Armato E., Spinato G., Spinato R. Focus harmonic scalpel compared to conventional haemostasis in open total thyroidectomy: a prospective randomized trial. Int J Otolaryngol. 2011. 2011:357195.

2.Hamberger B. History of thyroid surgery: the Kocher incision. Linos D, Chung WY, editors. Minimally Invasive Thyroidectomy. New York (NY): Springer;2012. p. 1–5.

3.Hannan SA. The magnificent seven: a history of modern thyroid surgery. Int J Surg. 2006. 4:187–91.

4.Anandaravi BN., Aslam MA., Nair PP. Prospective randomised study using focus harmonic scalpel versus conventional hemostasis for vessel ligation in open thyroid surgery. Int Surg J. 2017. 4:1431–7.

5.Chang YK., Lang BH. To identify or not to identify parathyroid glands during total thyroidectomy. Gland Surg. 2017. 6:S20–9.

6.Lorente-Poch L., Sancho JJ., Muñoz-Nova JL., Sánchez-Velázquez P., Sitges-Serra A. Defining the syndromes of parathyroid failure after total thyroidectomy. Gland Surg. 2015. 4:82–90.

7.Abate EG., Clarke BL. Review of hypoparathyroidism. Front Endocrinol (Lausanne). 2017. 7:172.

8.Hadker N., Egan J., Sanders J., Lagast H., Clarke B. Understanding the burden of illness associated with hypoparathyroidism reported among patients in the paradox study. Endocr Pract. 2014. 20:671–9.

9.Brindzjuk M., Krupp G., Kettritz U., Luft FC. Physician-induced hypocalcaemia, nephrocalcinosis, and incomplete distal renal tubular acidosis. Nephrol Dial Transplant. 2000. 15:1248–50.

10.Sheahan P., Mehanna R., Basheeth N., Murphy MS. Is systematic identification of all four parathyroid glands necessary during total thyroidectomy?: a prospective study. Laryngoscope. 2013. 123:2324–8.

11.Saint Marc O., Cogliandolo A., Piquard A., Famà F., Pidoto RR. LigaSure vs clamp-and-tie technique to achieve hemostasis in total thyroidectomy for benign multinodular goiter: a prospective randomized study. Arch Surg. 2007. 142:150–6.

12.Roye GD., Monchik J., Amaral JF. Endoscopic adrenalectomy using ultrasonic cutting and coagulating. Surg Technol Int. 2000. 9:129–38.

13.Laycock WS., Trus TL., Hunter JG. New technology for the division of short gastric vessels during laparoscopic Nissen fundoplication. Surg Endosc. 1996. 10:71–3.

14.Pogorelić Z., Perko Z., Družijanić N., Tomić S., Mrklić I. How to prevent lateral thermal damage to tissue using the harmonic scalpel: experimental study on pig small intestine and abdominal wall. Eur Surg Res. 2009. 43:235–40.

15.Yener O., Demir M., Yılmaz A., Yıgıtbaşı R., Atak T. Harmonic scalpel compared to conventional hemostasis in thyroid surgery. Indian J Surg. 2014. 76:66–9.

16.Cheng H., Soleas I., Ferko NC., Clymer JW., Amaral JF. A systematic review and meta-analysis of Harmonic Focus in thyroidectomy compared to conventional techniques. Thyroid Res. 2015. 8:15.

17.Melck AL., Wiseman SM. Harmonic scalpel compared to conventional hemostasis in thyroid surgery: a meta-analysis of randomized clinical trials. Int J Surg Oncol. 2010. 2010:396079.

18.Graff AT., Miller FR., Roehm CE. Predicting hypocalcemia after total thyroidectomy: parathyroid hormone level vs. serial calcium levels. Ear Nose Throat J. 2010. 89:462–5.

19.Gac P., Cabané P., Amat J., Huidobro F., Rossi R., Rodríguez F, et al. Incidence of hypocalcemia after total thyroidectomy. Rev Med Chil. 2007. 135:26–30.

20.Kang M., Ragan BG., Park JH. Issues in outcomes research: an overview of randomization techniques for clinical trials. J Athl Train. 2008. 43:215–21.

21.Schulz KF., Altman DG., Moher D. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMJ. 2010. 340:C332.

22.Vassiliou I., Tympa A., Arkadopoulos N., Nikolakopoulos F., Petropoulou T., Smyrniotis V. Total thyroidectomy as the single surgical option for benign and malignant thyroid disease: a surgical challenge. Arch Med Sci. 2013. 9:74–8.

23.Chindavijak S. Prediction of hypocalcemia in postoperative total thyroidectomy using single measurement of intra-operative parathyroid hormone level. J Med Assoc Thai. 2007. 90:1167–71.

24.Sperlongano P., Sperlongano S., Foroni F., De Lucia FP., Pezzulo C., Manfredi C, et al. Postoperative hypocalcemia: assessment timing. Int J Surg. 2014. 12:S95–7.

25.Praženica P., O'keeffe L., Holý R. Dissection and identification of parathyroid glands during thyroidectomy: association with hypocalcemia. Head Neck. 2015. 37:393–9.

Fig. 1.

CONSORT Flow Diagram for enrollment, allocation, follow-up, and analysis of patient participants. CONSORT = CONsolidated Standards of Reporting Trials; CSL = conventional suture ligation; HS = harmonic scalpel.

Table 1.

Baseline and pre-operative characteristics of the included patients

Baseline characteristic	CSL (n=38)	HS (n=38)	P value^†
Gender			0.033^∗
Male	13 (34.21)	12 (31.58)
Female	25 (65.79)	26 (68.42)
Age (yr)
Mean±SD	31.92±6.48	32.71±5.78	0.577
18–33	20 (52.63)	20 (52.63)	>0.999
34–40	18 (47.37)	18 (47.37)
Diagnosis			>0.999
Multinodular goitre	38 (100)	38 (100)

Values are presented as number (%).

CSL = conventional suture ligation; HS = harmonic scalpel; SD = standard deviation; ANOVA = analysis of variance.

^∗ Statistically significant at 5% level of significance

^† P values are based on χ² test for proportions and ANOVA for mean.

Table 2.

Postoperative hypocalcaemia and length of hospital stay by surgical technique

Postoperative hypocalcaemia by surgical technique	CSL (n=38)	HS (n=38)	P value^†
Calcium (mg/dL)
At 24 hr	8.00±1.05	8.56±0.96	0.018^∗
At 48 hr	8.28±1.04	8.09±1.03	0.013^∗
Postoperative hypocalcaemia			0.033^∗
Yes	14 (36.84)	6 (15.79)
No	24 (63.16)	32 (84.21)
Length of stay (day)	2.63±0.85	1.37±0.67	<0.001^∗

Values are presented as mean±SD or number (%).

CSL = conventional suture ligation; HS = harmonic scalpel

^∗ Statistically significant at 5% level of significance. P values are based on χ² test for proportions and ANOVA for mean.

Table 3.

Association of parathyroid identification with postoperative hypocalcaemia in both techniques

Method	Hypocalcaemia	Parathyroid not identified	Parathyroid identified	Fisher's exact test P value
CSL	Yes	6 (75)	8 (26.67)	0.019^∗
	No	2 (25)	22 (73.33)
HS	Yes	2 (25)	4 (13.33)	0.372
	No	6 (75)	26 (86.67)

CSL = conventional suture ligation; HS = harmonic scalpel.

^∗ Statistically significant at 5% level of significance.

Table 4.

Association of gender with postoperative hypocalcaemia in both techniques

Method	Hypocalcaemia	Male	Female	Fisher's exact test P value
CSL	Yes	65 (38.46)	9 (36)	0.577
	No	8 (61.54)	16 (64)
HS	Yes	1 (8.33)	5 (19.23)	0.369
	No	11 (91.67)	21 (80.77)

CSL = conventional suture ligation; HS = harmonic scalpel.

Table 5.

Association of age group with postoperative hypocalcaemia in both techniques

Method	Hypocalcaemia	18–33 yr	34–40 yr	Fisher's exact test P value
CSL	Yes	8 (40)	6 (33.33)	0.465
	No	12 (60)	12 (66.67)
HS	Yes	2 (10)	4 (22.22)	0.279
	No	18 (90)	14 (77.78)

CSL = conventional suture ligation; HS = harmonic scalpel.

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