**7. Discussion**

Recently, thyroid surgery is considered quite safe, thanks to the proper surgical techniques that kept complications at a minimum rate (2–3%) [17].

The introduction of the new sealing devices in thyroid surgery benefits both patients and the surgeons. LigaSure™ small jaw is a proper device used to perform total complete thyroidectomy, and it gives some technical advantages like: creates a clean surgical field providing better visibility, observed in other study [18]; no need to expose the vascular pedicles their dissection being possible using the device's forceps; reduces the operative time, also observed by Gac, Cabane and Hou Shan Yao [19, 20]; performs safe sealing of blood vessels, observed also by Marazzo and Lepner [20, 21]. This device can also remove the complications regarding the thread pathology.

The extracapsular total complete thyroidectomy can be performed without isthmectomy.

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 process (tumor or inflammatory).

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 laryngeal tracheal conduit.

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 surrounding tissues [22].

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 need of the evaluation of the technique [23].
