**6.2. Results**

**Figure 7.** Monobloc resection of the thyroid gland.

**6. Evaluation of the technique**

**6.1. Study description**

102 Cancer Survivorship

a monobloc resection of the gland (**Figure 7**).

Lobectomy ends with the separation of the isthmus, being an optional time, or we can achieve

In order to evaluate the feasibility of the technique, we conducted a prospective study which was carried out in Clinic of Surgery I, Emergency Clinical County Hospital Târgu Mureș from January 01, 2013 to June 01, 2017. The study enrolled 100 consecutive patients divided into two lots: 50 who underwent total complete thyroidectomy using LigaSure™ small jaw, including 10 with "monobloc resection" and 50 in whom total thyroidectomy was performed by conventional procedure (by using ligatures). The two groups were compared using statistical analysis following the next parameters: the thyroid pathology, operative time, hospitalization days, analgesia used and immediate postoperative complications. Statistical analysis was performed employing Student's test for comparison of the continuous variables. Differences between nonparametrical variables were compared using the Mann-Whitney U-test. Descriptive data

were reported as the mean ± SD. The level of significance was set at p < 0.05.

Control of the hemostasis, drainage of the thyroid cavity, intradermal resorbable suture.

Extracapsular thyroidectomy was performed in all patients.

Surgery consisted of performing total thyroidectomy and double drainage of the thyroid compartment.

The two groups included in this study had similar demographics (age, sex) and the thyroid pathology also being the same (**Table 4**).

In the evaluation of the operative time measured from the moment of the skin incision to wound closure, we have found that statistical data followed a Gaussian distribution and it could be interpreted by Student's t-test. The mean operative time in group 1 was 73.81 ± 16.96 min, which is significantly less than the operative time in the second group (conventional) 106.19 ± 31.66 min (**Table 5**).

To appreciate the length of hospital stay, we applied the nonparametric Mann-Whitney test, since the two groups did not have a Gaussian distribution pattern, because of the value of 17 days in group 1 and of 19 days in group 2. For group 1, the mean hospitalization time was of 4 days (range: 2–17 days), and for group 2, it was also 4 days (range: 3–19 days) (**Table 6**). We have not found statistically significant differences relating to these parameters of the patients in the two groups, regardless of the statistic method applied.


**Table 4.** Patient's demographic characteristics.


**Table 5.** Distribution of patients depending to the operative time.

#### 104 Cancer Survivorship


also by Marazzo and Lepner [20, 21]. This device can also remove the complications regarding

Thyroidectomy without Ligatures in Differentiated Thyroid Cancer

http://dx.doi.org/10.5772/intechopen.79730

105

Dissection of vascular pedicles is relatively easy, allowing sufficient exposure to a very narrow anatomical space, and the separation and preservation of the integrity of the laryngeal nerves and parathyroid glands are possible in the absence of invasion by the pathological

By lower temperature dispersion (1–2 mm) from the device's jaws, the nerve elements are spared, detaching the thyroid by cutting the Berry ligaments and avoiding burns in the laryn-

In order to avoid the possible thyroidectomy complications such as parathyroid trauma or laryngeal nerves injuries, a good hemostasis becomes the priority for the thyroid surgeons. Hemostasis achieved by classic methods such as tie and clamp, electrocautery, clips is time consuming and can lead to knot slipping and thermal trauma of the sur-

Nowadays, minimally invasive surgical techniques are used on a large scale in other surgical fields but thyroid gland resections, for both benign and malignant tumors are rarely performed. Zorron et al. described an endoscopic approach in patients without preexisting neck operations using transoral-vestibular approach but with the limitation of the study due to the

Total and "complete" thyroidectomy represents a feasible technique in our days.

Using the vessel sealing devices brings real benefits both for patients and surgeons.

In surgical services that do not have assisted video surgery, this technique can be considered

Publications of this chapter has been funded by the "Toma Ionescu" Foundation, Gheorghe

In our opinion, based on the results, this technique can be considered safe.

The extracapsular total complete thyroidectomy can be performed without isthmectomy.

the thread pathology.

geal tracheal conduit.

rounding tissues [22].

**8. Conclusion**

need of the evaluation of the technique [23].

"gold standard" in selected cases.

Marinescu Street no. 50, Targu-Mures, Romania.

**Acknowledgements**

**Conflict of interest**

There is nothing to declare.

process (tumor or inflammatory).

**Table 6.** Distribution of patients depending on length of hospitalization.


**Table 7.** Complications in the two groups.

The evaluation of postoperative analgesia was performed by measuring the dose of analgesic drugs administered to each patient. The nonparametric Mann-Whitney test had been applied considering that the two groups did not have a Gaussian distribution (because of a maximal value of 17 days observed in the LigaSure-group and a maximal value of 19 days identified in the conventional group). The mean period of analgesia in group 1 was 2.5 days (range 1–16 days), while in group 2, it was 3 days (range: 2–19 days). There was no statistically significant difference between the period of analgesic drug requirement in the two groups (p = 0.06).

No patients developed manifestations of hypocalcemia (hypoparathyroidism). There were few patients who experienced a change in voice (low pitched voice) seen in three patients from group 1 and in four patients in group 2. Hematoma was observed in two patients belonging to group 1 and in four patients belonging to group 2. There is no statistic significant difference between the incidence of early postoperative complications in the two groups (**Table 7**).
