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01-12-2013 | Systematic Reviews and Meta-analyses

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

Authors: Pietro Contin, Käthe Gooßen, Kathrin Grummich, Katrin Jensen, Hubertus Schmitz-Winnenthal, Markus W. Büchler, Markus K. Diener

Published in: Langenbeck's Archives of Surgery | Issue 8/2013

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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Title: ENERgized vessel sealing systems versus CONventional hemostasis techniques in thyroid surgery—the ENERCON systematic review and network meta-analysis
Authors: Pietro Contin
Käthe Gooßen
Kathrin Grummich
Katrin Jensen
Hubertus Schmitz-Winnenthal
Markus W. Büchler
Markus K. Diener
Publication date: 01-12-2013
Publisher: Springer Berlin Heidelberg
Published in: Langenbeck's Archives of Surgery / Issue 8/2013
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-013-1137-7

At a glance: The STEP trials

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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