Energy-based devices reduced surgical complications in pediatric patients who underwent thyroidectomy for indications such as medullary thyroid carcinoma (MTC), according to a new study published in the Journal of Pediatric Surgery.

The use of energy-based devices including electrothermal bipolar vessel sealing system and ultrasonically-activated shears during pediatric thyroidectomy led to reduced rates of hypoparathyroidism, operative time, and length of hospital stay. Energy-based devices are used to help seal cut vessels and provide hemostasis.

A group of 177 patients (group A) with thyroid disease underwent thyroidectomy with energy-based devices while another group of 237 patients (group B) received thyroidectomy with conventional clamp-and-tie techniques. Both groups were matched for sex, age, and indication for surgery.


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Patients in group A experienced lower rates of transient (11.3% vs 19%; P <.05) and permanent (1.7% vs 5.5%; P <.05) postoperative hypoparathyroidism compared to group B. Postoperative bleeding occurred in 3 patients in group B compared to 0 in group A.

“These results cannot be overlooked due to the impact that the surgical-related complications could have on the quality of life of pediatric patients,” the authors said.

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When analyzed by specific indication for surgery, there was no significant difference in the rate of transient and permanent hypoparathyroidism in patients with suspected MTC due to germline mutations in the RET gene. This is most likely due to the fact that only 1 patient in each group experienced hypoparathyroidism.

Mean operation time was significantly lower in group A than group B as well (53.9±16.4 min vs 59.2±20.4 min; P <.05). Patients with suspected MTC showed a trend towards shorter operating times (57.2±22.9 min vs 61.15±15 min), however, the results were nonsignificant (P =.39).

A major criticism of energy-based devices during thyroidectomy is the potential for thermal injury to the recurrent laryngeal nerve (RLN), the authors said. However, the distribution of RLN was similar between groups with only 2 patients from each experiencing transient RLN palsy and no patients experiencing permanent recurrent laryngeal nerve palsy.

Reference

De Napoli L, Matrone A, Ambrosini CE, et al. Impact of energy-based devices in pediatric thyroid surgery. J Pediatr Surg. Published online March 15, 2022. doi:10.1016/j.jpedsurg.2022.03.008