Effect of energy-based devices on post-operative parathyroid function and blood calcium levels after total thyroidectomy

ABSTRACT

Introduction: Energy-based devices are widely used in thyroid surgery in order to achieve optimal hemostasis, while their role in the incidence of hypocalcemia and hypoparathyroidism comprises a topic evaluated in numerous studies.

Areas covered: The aim of this systematic review is to investigate the potential benefit of Ultrasonic Shears and Electrothermal Bipolar (Radiofrequency) System in thyroid surgery regarding the incidence of post-operative hypocalcemia and hypoparathyroidism. A systematic review of the literature in PubMed/Medline and Scopus databases was conducted. Forty-nine studies met the inclusion criteria and were analyzed. A statistically decreased rate of transient hypocalcemia and hypoparathyroidism was reported in 15 studies and 4 studies, respectively, when using energy-based devices. However, 18 and 13 surveys examined transient hypocalcemia and hypoparathyroidism, respectively, and demonstrated no statistical difference between energy-based devices and conventional hemostasis. No difference was observed between the groups concerning permanent hypocalcemia. Out of 13 studies, only 2 showed a significant reduction in the occurrence of permanent hypoparathyroidism in the energy-based device group.

Expert opinion: Energy-based devices reduced the rate of transient hypocalcemia and hypoparathyroidism after thyroid surgeries in 42.8% and 23.5% of the included studies, respectively. Further studies are needed to evaluate their impact on permanent post-operative hypocalcemia and hypoparathyroidism.

Keywords:

• Energy-based devices
• Harmonic Scalpel
• LigaSure
• conventional hemostasis
• thyroid surgery
• hypocalcemia
• hypoparathyroidism

Article Highlights

• Careful hemostatic methods are required in order to avoid intraoperative bleeding and damage to the surrounding tissues.

• The growing usage of EBDs, including EBS and US, has been associated with decreased bleeding occurrence and operative time in many types of surgeries as well as in thyroid surgery.

• Both EBS and US have been associated with decreased incidence of thermal tissue injury and lower risk of damage to the surrounding structures along with efficient hemostasis and reduced intraoperative bleeding, providing better identification of surrounding structures, such as parathyroid glands and the recurrent laryngeal nerve.

• Out of the 53 included studies, 15 (42.8%) showed a statistically reduced hypocalcemia rate (p<0.05) in patients treated with EBDs, while 2 (5.71%) estimated a lower incidence (p<0.05) of transient hypocalcemia in the conventional group.

• A statistically decreased incidence of transient hypoparathyroidism (p<0.05) was noticed in the EBD group in 4 out of 17 studies (23.5%), while 13 (76.5%) articles detected no significant difference between patients treated with EBDs and conventional techniques.

• Thirteen studies concluded to a not significant difference between the EBD and the conventional patients, concerning the incidence of permanent hypocalcemia, while permanent hypoparathyroidism was evaluated in 13 studies; 2 of them (15.4%) demonstrated a statistically lower occurrence in the EBD group compared to the conventional one, while 11 papers (84.6%) calculated no important difference between the two groups.

Declaration of Interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.