Meta-analysis of thyroidectomy with ultrasonic dissector versus conventional clamp and tie

World Journal of Surgical Oncology

Review

Antonio Basoli¹  Alberto Santoro²  Adriano Redler²  Domenico Giannotti²  Giorgio Di Rocco²  Domenico Vendettuoli²  Alessandro Sanguinetti³  Nicola Avenia³  Fabio D'Ajello³  Roberto Cirocchi⁴  Fabio Rondelli⁴  Stefano Trastulli⁴  Liliana Minelli⁵ 

[1] Department Paride Stefanini, Sapienza University of Rome, Rome, Italy;Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy;Endocrine Surgical Unit. Department of Surgical Sciences, Radiology and Dentistry, University of Perugia, Perugia, Italy;General and Emergency Surgical Unit. Department of Surgical Sciences, Radiology and Dentistry, University of Perugia, Perugia, Italy;Public Health Department, University of Perugia, Perugia, Italy;

关键词: Total Thyroidectomy;    Weighted Mean Difference;    Harmonic Scalpel;    Operative Duration;    Central Neck Dissection;   

DOI  :  10.1186/1477-7819-8-112

 received in 2010-09-08, accepted in 2010-12-23,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundWe conducted a systematic review to evaluate the role of Ultrasonic dissector (UAS) versus conventional clamp and tie in thyroidectomy.Materials and methodsWe searched for all published RCT in into electronic databases. To be included in the analysis, the studies had to compare thyroidectomy with UAS versus conventional vessel ligation and tight (conventional technique = CT). The following outcomes were used to compare the total thyroidectomy group with UAS versus CT group: operative duration, operative blood loss, overall drainage volume during the first 24 hours, transiet laryngeal nerve palsy, permanent laryngeal nerve palsy, transiet hypocalcaemia and permanent hypocalcaemia.ResultsThere are currently 7 RCT on this issue to compare thyroidectomy with UAS versus CT. From the analysis of these studies it was possible to confront 608 cases: 303 undergoing to thyroidectomy with UAS versus 305 that were treated with CT. Actually, it was shown a relevant advantage of cost-effectiveness in patients treated with UAS; there is a statistically significant reduction of the operative duration (weighted mean difference [WMD], -18.74 minutes; 95% confidence interval [CI], (-26.97 to -10.52 minutes) (P = 0.00001), intraoperative blood loss (WMD, -60.10 mL; 95% CI, -117.04 to 3.16 mL) (P = 0.04) and overall drainage volume (WMD, -35.30 mL; 95% CI, -49.24 to 21.36 mL) (P = 0.00001) in the patients underwent thyroidectomy with UAS. Although the analysis showed that the patients who were treated with USA presented more favourable results in incidence of post-operative complications (transient laryngeal nerve palsy: P = 0.11; permanent laryngeal nerve palsy: not estimable; transient hypocalcaemia: P = 0.24; permanent hypocalcaemia: P = 0.45), these data didn't present statistical relevance.ConclusionThis meta-analysis shown a relevant advantage only in terms of cost-effectiveness in patients treated with UAS; it is subsequent to statistically significant reduction of operation duration, intraoperative blood loss and of overall drainage volume during the first 24 hours. Although the analysis showed that the patients who were treated with UAS presented more favourable results in incidence of post-operative complications (transiet laryngeal nerve palsy; transiet hypocalcaemia and permanent hypocalcaemia), these data didn't present statistical relevance.

【 授权许可】

CC BY   
© Cirocchi et al; licensee BioMed Central Ltd. 2010