= 819 operations) and group II (conventional ligature, = 337 operations).

= 819 operations) and group II (conventional ligature, = 337 operations). II (conventional ligature), there were 337 thyroid gland surgeries (600 lobes). The male to female ratio was 1/5.4. In group I, the ratio of revisions to surgery was 15 to 819 (1.83%). In group II, revision due to bleeding was performed 14 times in 337 surgeries (4.15%). The total postoperative bleeding rate was 2.51%, and all revisions were performed within 24 hours after surgery. The ratio of revisions to surgery was significantly lower in group I (BiClamp) compared with surgery with conventional ligature (= 0.022). RLN palsy was observed in 22/1522 (1.45%) lobes in group I and 12/600 (2.0%) in group II. No significant difference between groups was observed (= 0.36). The average standard deviation duration of total thyroidectomy was 89.6 27.6 minutes in group I and 122.9 37.7 minutes in group II (Table 1). The average duration of surgery was decreased by 25.99% (Figure 2). The difference in time saving in group I was statistically significant compared with group II (< 0.001). Figure 2 Duration of surgery in minutes for group I (BiClamp) and group II (ligature). Table 1 Duration of surgery in minutes according to extent of the surgery. 4. Discussion In the past few years, novel methods of vessel sealing without using conventional ligature have emerged [2C6]. In addition to spray coagulation or harmonic 417716-92-8 supplier scalpel, there is also the principle of bipolar tissue thermofusion as used by BiClamp 150 [3]. In our department, this system is frequently used in thyroid gland surgery. Traditionally, use of electrosurgical bipolar thermofusion systems spread to head and neck surgery from abdominal surgery and gynecology [4]. A randomized study by Silva-Filho in 45 patients with vaginal hysterectomies showed shorter operative times, faster recovery, lower perioperative blood loss, and less pain with the bipolar vessel sealing system compared with conventional sutures [4]. However, since 2003 several studies have reported successful usage of bipolar vessel sealing systems in thyroidectomy [5C7]. In his comparable study of 155 patients, Franko et al. emphasize that LigaSure bipolar electrosealer, when used as the primary means of hemostasis during thyroidectomy, significantly reduced mean operative times, whereas the rates of perioperative complications were unchanged [5]. Lachanas et al. obtained similar findings during thyroid surgery with LigaSure in 72 consecutive patients. There was a mean reduction in operative time of 23 minutes compared WT1 with previous surgical thyroid procedures when a bipolar vessel sealing system was not used [6]. Manouras et al. compared the outcome of thyroidectomy using an electrothermal bipolar vessel sealing system (= 148), the harmonic scalpel (= 144), and classic suture ligation techniques (= 90). Compared with the classic technique, surgical time was reduced by about 20% when a bipolar sealer or harmonic scalpel was used. The 3 groups were similar in terms of perioperative complications, hospital stay, and thyroid gland pathology [7]. Data in the literature show rates of about 1.72C4.2% 417716-92-8 supplier postoperative bleeding that require revision of thyroidectomy wounds [8C10]. In a study of 30,142 thyroid gland operations, Promberger et al. observed postoperative bleeding in 1.7% [8]. Risk factors identified were older age, male sex, extent of the resection, bilateral procedure, and operations for recurrent disease. The risk of postoperative bleeding doubled during bilateral thyroid surgery compared with unilateral surgery, occurring in 2.0% of bilateral operations compared with 1% of unilateral operations [8]. A high frequency of total thyroidectomy (663/819 in group I, 250/337 in group II) in our cohort is probably one of the factors that influenced the higher frequency of postoperative bleeding (the number of vessels treated is doubled during total thyroidectomy). Morton et al. identified a postoperative systolic blood pressure of greater than 150?mmHg as a major significant factor associated with an increased risk of hemorrhage following thyroid surgery [9]. Finally, 417716-92-8 supplier the method of vessel sealing influenced the postoperative bleeding rate. Saint Marc et al. in his prospective study of 200 patients found that 1 patient in the LigaSure group (= 100) and 2 patients in the.