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ENERgized vessel sealing systems versus CONventional hemostasis techniques in thyroid surgery—the ENERCON systematic review and network meta-analysis

  • Systematic Reviews and Meta-analyses
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Abstract

Purpose

Energized vessel-sealing systems have been proposed to save operation time and reduce post-operative complications. The aim of the present systematic review was to compare operation time and postoperative morbidity for ultrasonic and electrothermal bipolar-activated devices with conventional hemostasis techniques and with each other in open thyroidectomy.

Methods

A systematic literature search (MEDLINE, Cochrane Library, EMBASE and ISI Web of Science) was performed to identify randomised controlled trials (RCTs) comparing conventional hemostasis techniques, ultrasonic devices (Harmonic® scalpel) and/or electrothermal bipolar-activated vessel sealing systems (Ligasure®) during open thyroidectomy. For the primary endpoint (operation time), a network meta-analysis with Bayesian random effects model was performed. Pairwise meta-analyses with random effects were calculated for primary and secondary endpoints.

Results

One hundred sixteen publications were evaluated for eligibility; 35 RCTs (4,061 patients) were included. There was considerable methodological and clinical heterogeneity of included trials. The Harmonic scalpel significantly reduced operation time compared with conventional techniques (22.26 min, 22.7 min in the inconsistency model). The use of Ligasure significantly reduced operation time in total thyroidectomy (13.84 min in the consistency model, 12.18 min in the inconsistency model). In direct comparison, operations with the Harmonic scalpel were faster than with Ligasure (8.42 min in the consistency model, 2.45 min in the inconsistency model). The rates of recurrent nerve palsy and postoperative hypocalcaemia did not significantly differ in the intervention groups.

Conclusions

This meta-analysis shows superiority of ultrasonic devices in terms of operation time compared with conventional hemostasis techniques in thyroid surgery, with no detriment to safety outcomes.

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Authors and Affiliations

  1. Department of General-, Visceral- and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Pietro Contin, Hubertus Schmitz-Winnenthal, Markus W. Büchler & Markus K. Diener

  2. Study Centre of the German Surgical Society, University of Heidelberg, Heidelberg, Germany

    Pietro Contin, Käthe Gooßen, Kathrin Grummich, Markus W. Büchler & Markus K. Diener

  3. Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany

    Katrin Jensen

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Authors’ contributions

Pietro Contin: Literature search, Data extraction, Risk of bias assessment, Manuscript draft

Käthe Gooßen: Updated literature search, Duplicate data extraction, Risk of bias assessment, Reviewed statistical analysis, Reviewed manuscript

Kathrin Grummich: Updated literature search, Duplicate data extraction, Risk of bias assessment

Katrin Jensen: planned, performed and interpreted the statistical analysis

Hubertus Schmitz-Winnenthal: Helped to draft the manuscript

Markus W. Büchler: Helped to draft the manuscript

Markus K. Diener: Helped to draft the manuscript and helped in the analysis and interpretation of data

PC carried out the search, extracted the data, assisted in the risk of bias assessment and drafted the manuscript. KGo and KGr updated the search, performed the duplicate data extraction and assessed the risk of bias. KGo updated and critically reviewed the statistical analysis and manuscript draft. KJ planned, performed and interpreted the statistical analysis. MD helped to draft the manuscript and helped in the analysis and interpretation of data. HSW and MWB helped to draft the manuscript. All authors read and approved the final manuscript.

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Contin, P., Gooßen, K., Grummich, K. et al. ENERgized vessel sealing systems versus CONventional hemostasis techniques in thyroid surgery—the ENERCON systematic review and network meta-analysis. Langenbecks Arch Surg 398, 1039–1056 (2013). https://doi.org/10.1007/s00423-013-1137-7

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