Coerper Stephan, Stengl Wolfgang
Chirurgie, Krankenhaus Martha-Maria, Nürnberg, Deutschland.
Zentralbl Chir. 2018 Oct;143(5):543-549. doi: 10.1055/s-0043-102570. Epub 2017 May 9.
This study investigated whether the use of the vessel sealing device LigaSure Small Jaw is cost-effective and safe in thyroid surgery despite the high cost of material.
We analysed the results of 224 thyroid operations performed by the same surgeon in three time intervals. We included thyroidectomies and bilateral near-total resections (including Dunhill surgery). Minimally-invasive resections (MIVAT), unilateral resections or subtotal resections (remains > 2 ml), patients with recurrent goiter, operations with neck dissections and sternotomies were excluded. In 72 procedures carried out during the first interval (1/2011 - 6/2011), the surgeon only used the clamp-and-tie technique. In the other two intervals (II: 7/2012 - 12/2012, n = 81 and III: 1/2014 - 6/2014: n = 71), the LigaSure Small Jaw was used. We investigated operation time (cut-seam time) and the complication rates between the groups (transient/permanent laryngeal nerve palsy, severe bleeding causing reoperation and hypocalcaemia, defined as Ca < 2.0 mmol/l). Differences were calculated with the t-test and the Wilcoxon rank test. Values are given as mean ± SEM.
Specimen weight and the indication for surgery (nodular goiter or Basedow's disease) were comparable in all groups, but there were fewer thyroidectomies performed in the first interval (p = 0.009). There was no difference in complication rates between the groups, such as the rate of transient laryngeal nerve palsy in % (I: 2.17; II: 1.92; III 1.44) and postoperative hypocalcaemia in % (I: 20.8; II: 21.0; III 15.5). The use of the LigaSure Small Jaw in thyroidectomy procedures led to a significant reduction of operation time (II: Δ 27.4 min; III: Δ 25.6 min; p = 0.0001) compared to interval I. This was also found for bilateral near-total resections (II: Δ 24.3 min; III Δ 32.1 min; p = 0.0001). The InEK calculation for thyroidectomy procedures estimated personnel expenses in the OR to be about 1233 €. A 31-min reduction in operation time would save 440 € of personnel expenses.
The use of the LigaSure Small Jaw during thyroid surgery is safe and cost-effective for thyroidectomy procedures and bilateral near-total resections.
本研究调查了尽管血管闭合装置LigaSure Small Jaw材料成本高昂，但在甲状腺手术中使用该装置是否具有成本效益且安全。
我们分析了同一位外科医生在三个时间段内进行的224例甲状腺手术的结果。纳入了甲状腺切除术和双侧近全切除术（包括邓希尔手术）。排除了微创切除术（MIVAT）、单侧切除术或次全切除术（残留>2 ml）、复发性甲状腺肿患者、颈部清扫术和胸骨切开术的手术。在第一个时间段（2011年1月 - 2011年6月）进行的72例手术中，外科医生仅使用了钳夹结扎技术。在另外两个时间段（II：2012年7月 - 2012年12月，n = 81；III：2014年1月 - 2014年6月：n = 71），使用了LigaSure Small Jaw。我们调查了手术时间（切割缝合时间）以及各组之间的并发症发生率（暂时性/永久性喉返神经麻痹、导致再次手术的严重出血和低钙血症，定义为Ca <2.0 mmol/l）。差异通过t检验和Wilcoxon秩和检验计算。数值以平均值±标准误表示。
所有组的标本重量和手术指征（结节性甲状腺肿或格雷夫斯病）具有可比性，但第一个时间段进行的甲状腺切除术较少（p = 0.009）。各组之间的并发症发生率没有差异，例如暂时性喉返神经麻痹发生率（%）（I：2.17；II：1.92；III：1.44）和术后低钙血症发生率（%）（I：20.8；II：21.0；III：15.5）。与第一个时间段相比，在甲状腺切除术中使用LigaSure Small Jaw导致手术时间显著缩短（II：减少27.4分钟；III：减少25.6分钟；p = 0.0001）。双侧近全切除术也有同样的结果（II：减少24.3分钟；III：减少32.1分钟；p = 0.0001）。甲状腺切除术的InEK计算估计手术室的人员费用约为1233欧元。手术时间减少31分钟将节省440欧元的人员费用。
在甲状腺切除术和双侧近全切除术中，术中使用LigaSure Small Jaw是安全且具有成本效益的。
