Vol. 9, Issue 3, Part B (2025)

Background: Total thyroidectomy is a cornerstone surgical intervention for both benign and malignant thyroid pathologies. Achieving hemostasis while preserving critical structures - notably the recurrent laryngeal nerves (RLNs) and parathyroid glands - remains a technical challenge. The classical suture ligation (CSL) technique, though time-tested, is labor-intensive and demands meticulous manual dexterity. In contrast, energy-based vessel sealing systems, particularly LigaSure™, offer a modern sutureless approach (SL) that fuses vessel walls through controlled bipolar energy, potentially enhancing efficiency and reducing tissue trauma. Despite growing adoption, high-quality comparative data on surgical, clinical, and ergonomic outcomes between CSL and SL-LigaSure™ in total thyroidectomy remain limited.
Methods: This prospective, single-center, randomized controlled trial was conducted between January 2022 and December 2023. A total of 120 adult patients (ASA I-II) undergoing total thyroidectomy for benign or malignant indications were equally randomized into two groups: Group A (n=60) underwent surgery using classical vicryl suture ligation, while Group B (n=60) utilized the LigaSure™ Maryland Jaw device (Medtronic) for all vascular control without clips or ties. All procedures were performed by a single experienced endocrine surgeon. Primary endpoints included operative duration and intraoperative blood loss. Secondary outcomes encompassed: (1) postoperative complications - transient and permanent hypocalcemia, RLN palsy (clinical and laryngoscopic), hematoma, and seroma; (2) recovery metrics - time to oral intake, drain removal, hospital discharge, and return to daily activities; and (3) intraoperative field quality and surgeon satisfaction assessed via standardized 10-point visual analog scales immediately post-procedure.
Results: Baseline demographics and thyroid pathology were comparable between groups. Operative time was significantly reduced in the LigaSure™ group (78.2±12.4 min vs. 104.6±18.7 min; p<0.001). Mean intraoperative blood loss was nearly halved (35.4±10.2 mL vs. 68.7±22.5 mL; p<0.001). Rates of transient hypocalcemia were lower in Group B (11.7% vs. 20.0%; p=0.21), with no cases of permanent hypoparathyroidism in the LigaSure™ arm versus one in the CSL group (p=0.32). Transient RLN injury occurred in 1.7% (LigaSure™) vs. 3.3% (CSL; p=0.56). No hematomas requiring reoperation occurred in Group B. Recovery was accelerated: oral intake began earlier (4.5 vs. 8.2 hours; p<0.001), drains were removed sooner or omitted entirely (1.0 vs. 1.8 days; p<0.001), hospital stay was significantly shorter (1.2±0.4 vs. 2.1±0.7 days; p<0.001), and return to work was faster (9.1 vs. 14.3 days; p<0.001). Critically, surgeon-reported field clarity (8.9 vs. 6.8/10), tissue handling ease (9.1 vs. 6.5/10), and overall satisfaction (9.3 vs. 7.0/10) were all markedly superior with LigaSure™ (all p<0.001).
Conclusion: The sutureless LigaSure™ technique demonstrates clear advantages over classical suture ligation in total thyroidectomy, offering substantial reductions in operative time and blood loss, accelerating patient recovery, and enhancing intraoperative ergonomics and surgeon satisfaction - all without increasing the risk of major complications. These findings support the adoption of LigaSure™ as a first-line hemostatic modality in thyroid surgery, particularly in high-volume or efficiency-driven surgical settings.