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Harmonic versus LigaSure for Flap Creation in Bilateral Axillary Breast Approach Thyroid Surgery

Journal of Endocrine Surgery 2020년 20권 4호 p.69 ~ 77
류한별, 안종혁, 김재환, 최성운, 최윤숙, 이진욱,
소속 상세정보
류한별 ( Ryu Han-Byul ) - Inha University College of Medicine Inha University Hospital Department of Surgery
안종혁 ( Ahn Jong-Hyuk ) - Seoul National University College of Medicine Seoul National University Hospital Department of Surgery
김재환 ( Kim Jae-Hwan ) - Inha University College of Medicine Inha University Hospital Department of Surgery
최성운 ( Choi Seong-Woon ) - Inha University College of Medicine Inha University Hospital Department of Surgery
최윤숙 ( Choi Yun-Suk ) - Seoul National University College of Medicine Seoul National University Hospital Department of Surgery
이진욱 ( Yi Jin-Wook ) - Inha University College of Medicine Inha University Hospital Department of Surgery

Abstract


Purpose: The bilateral axillary breast approach (BABA) is frequently utilized for remote access thyroid surgery. The first step in this surgical approach is to make a subcutaneous flap from the axilla to the neck, usually using a Harmonic ACE. Our institution has utilized LigaSure to create these flaps. This study reports comparative results with these 2 energy devices.

Methods: Medical data and video clips from 73 patients who underwent robotic BABA thyroid surgery were retrospectively reviewed. Flaps for BABA were created by first and second year endocrine fellows under the guidance of an experienced endocrine surgeon. There were no criteria for allocation to energy devices.

Results: Of the 73 patients, 31 and 42 underwent flap creation with the Harmonic ACE and LigaSure devices, respectively. Demographic characteristics were similar in the 2 groups. Mean time for flap creation was significantly shorter (33.46±8.33 vs. 38.27±7.14 min, P=0.012), and mean number of camera cleanings significantly lower (4.21±2.53 vs. 10.45±4.95, P<0.001), in the LigaSure group. Surgical site pain on day 2 was significantly lower in the LigaSure group. Postoperative bleeding and skin burn occurred only in patients in the Harmonic group.

Conclusion: LigaSure showed better performance than the Harmonic ACE device for BABA flap creation, as shown by time for flap creation, postoperative pain scores, and complications. Because this study was a small sized retrospective comparison, large randomized controlled trials are needed to confirm these results.

키워드

Thyroid neoplasms; Robotic surgical procedures; Surgical flap; Electrosurgery

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