Cirocchi Roberto, Matteucci Matteo, Lori Eleonora, D'Andrea Vito, Arezzo Alberto, Pironi Daniele, Avenia Stefano, Randolph Justus, Tiraboschi Ileana, Tebala Giovanni Domenico, Popivanov Georgi I, Sorrenti Salvatore
Department of General Surgery, University of Perugia, Terni.
Department of General Surgery, University of Milan, Milan.
Int J Surg. 2024 Dec 1;110(12):8083-8096. doi: 10.1097/JS9.0000000000002113.
One of the most important surgical steps during thyroidectomy is the safe ligation of vessels. In fact, it is crucial to avoid postoperative bleeding and nerves' injury. The "clamp and tie" technique was first introduced in the 19th century. Since then, a lot of other techniques have been adopted to facilitate the safe ligation and sectioning of thyroidal vessels; however, one of the most relevant advances is the introduction of energy-based devices (EBDs), which occurred three decades ago.
The aim of this systematic review and meta-analysis is to evaluate the safety and effectiveness of sutureless FOCUS harmonic scalpel (second-generation EBDs) versus conventional clamps-and-tie technique) in total thyroidectomy.
This systematic review and meta-analysis represent the largest comparison in the literature between the thyroidectomy procedure with the second-generation advanced harmonic scalpel ultrasonic focus (UAS FOCUS) versus the conventional clamp-and-tie (CT) technique: as a matter of fact, it includes 43 randomized controlled trials (RCTs) and a total of 10 361 patients. The incidence of transient recurrent laryngeal nerve palsy was statistically lower in patients undergoing UAS (3.99%) rather than CT (5.23%) (RR 0.79, 95% CI 0.63-0.99). The incidence of transient hypocalcemia was 11.3% in patients who underwent thyroidectomy with UAS FOCUS and 15.4% in those who underwent thyroidectomy with CT.
Sutureless EBD is associated with a lower risk of damage to the laryngeal nerves and parathyroid glands. The rate of hypocalcemia and nerve paresis is indeed lower due to less thermic damage. Sutureless EBD can also diminish the rate of postoperative bleeding and cervical hematoma, a rare but potentially fatal complication.
甲状腺切除术中最重要的手术步骤之一是安全结扎血管。事实上，避免术后出血和神经损伤至关重要。“钳夹结扎”技术于19世纪首次引入。从那时起，人们采用了许多其他技术来促进甲状腺血管的安全结扎和切断；然而，最相关的进展之一是基于能量的设备（EBDs）的引入，这发生在三十年前。
本系统评价和荟萃分析的目的是评估无缝合FOCUS谐波刀（第二代EBDs）与传统钳夹结扎技术在全甲状腺切除术中的安全性和有效性。
本系统评价和荟萃分析代表了文献中第二代先进谐波刀超声聚焦（UAS FOCUS）甲状腺切除术与传统钳夹结扎（CT）技术之间最大规模的比较：事实上，它包括43项随机对照试验（RCT），共10361例患者。接受UAS治疗的患者暂时性喉返神经麻痹的发生率在统计学上低于接受CT治疗的患者（3.99%对5.23%）（RR 0.79，95%CI 0.63-0.99）。接受UAS FOCUS甲状腺切除术的患者暂时性低钙血症的发生率为11.3%，接受CT甲状腺切除术的患者为15.4%。
无缝合EBD与喉神经和甲状旁腺损伤风险较低相关。由于热损伤较小，低钙血症和神经麻痹的发生率确实较低。无缝合EBD还可以降低术后出血和颈部血肿的发生率，颈部血肿是一种罕见但可能致命的并发症。
