LIGASURE VERSUS CONVENTIONAL TECHNIQUES IN THYROIDECTOMY: A COMPARATIVE ANALYSIS.

Thyroid disorders are among the most common endocrine conditions encountered in surgical practice, ranging from benign multinodular goitre to malignant thyroid neoplasms.1 Thyroidectomy remains the definitive treatment for many of these conditions and is one of the most frequently performed head and neck surgical procedures worldwide.2 Despite being a routine operation, thyroidectomy is associated with potential complications such as intraoperative bleeding, postoperative hematoma, recurrent laryngeal nerve injury, and hypocalcemia, which can significantly impact patient outcomes.3

Traditional thyroidectomy techniques rely on suture ligation and monopolar or bipolar electrocautery for vessel control and haemostasis.4 While effective, these methods can be time-consuming and may be associated with thermal spread, increased tissue handling, and variable haemostatic efficiency, particularly in highly vascular thyroid tissue. These factors may contribute to increased operative time and postoperative drain output, thereby prolonging hospital stay and recovery.5

In recent years, advancements in surgical technology have introduced energy-based vessel sealing devices designed to improve haemostatic control.6 Among these, LigaSure is a bipolar electrothermal device that achieves permanent vessel sealing through controlled delivery of energy, denaturing collagen and elastin within the vessel wall. It can effectively seal vessels up to 7 mm in diameter with minimal lateral thermal spread, thereby reducing the need for clips or sutures.7,8

The use of LigaSure in thyroid surgery has gained attention due to its potential advantages, including reduced operative time, improved haemostasis, decreased blood loss, and lower drain output.9 By minimizing intraoperative bleeding, it enhances the clarity of the surgical field, potentially improving precision and safety during dissection near critical structures such as the recurrent laryngeal nerve and parathyroid glands. Additionally, reduced tissue trauma may contribute to faster postoperative recovery and shorter hospital stay.10

However, despite these theoretical and observed advantages, the extent of benefit offered by LigaSure over conventional techniques remains a subject of clinical evaluation. Variability in surgical expertise, patient characteristics, and institutional protocols necessitates further comparative studies to establish its definitive role in routine thyroidectomy practice, especially in resource-constrained settings. The present study is therefore undertaken to compare LigaSure with conventional surgical techniques in thyroidectomy, focusing on key intraoperative and postoperative parameters to determine whether its use translates into measurable clinical benefits.

AIMS AND OBJECTIVES

•              To compare the efficacy and safety of LigaSure versus conventional surgical techniques in thyroidectomy.

The study was conducted over a period of 15 months at Sree Mookambika Institute of Medical Sciences from January 2025 to March 2026. A total of 80 patients undergoing thyroidectomy for benign or malignant thyroid diseases were enrolled after obtaining informed written consent. Preoperative evaluation included detailed history, clinical examination, thyroid function tests, neck ultrasonography, and fine needle aspiration cytology wherever indicated. Patients were randomly assigned into two equal groups of 40 each.

Inclusion Criteria

•              Patients aged 18 years and above undergoing thyroidectomy for benign or malignant thyroid diseases

•              Patients with euthyroid or medically controlled thyroid function

•              Patients fit for surgery under general anaesthesia

•              Patients providing informed written consent

•              Patients with indications for total or hemithyroidectomy

Exclusion Criteria

•              Patients with uncontrolled hyperthyroidism or thyroid storm

•              Patients with recurrent thyroid surgery or previous neck surgeries

•              Patients with advanced malignancy requiring extended neck dissection

•              Patients unfit for general anaesthesia due to severe comorbidities

•              Patients who did not consent for participation or were lost to follow-up

In Group A, thyroidectomy was performed using the LigaSure vessel sealing system, while in Group B, conventional suture ligation and electrocautery techniques were used for haemostasis. All surgeries were performed under general anaesthesia by experienced surgeons following standard thyroidectomy protocols. Intraoperative parameters such as operative time (from skin incision to closure) and estimated blood loss were carefully recorded. Blood loss was calculated based on suction volume and number of soaked gauze pads.'

After completion of surgery, a closed suction drain was placed in all patients, and drain output was measured every 24 hours until removal. Postoperative pain was assessed using a standard pain scale, and wound site was examined for hematoma, seroma, or infection. Serum calcium levels were monitored to detect hypocalcemia, and vocal cord function was assessed when clinically indicated to rule out recurrent laryngeal nerve injury.

Patients were followed up daily during hospital stay and subsequently during outpatient visits to assess recovery and detect any late complications. Duration of hospital stay was recorded for each patient. All clinical data were systematically documented in a structured proforma and later analyzed statistically to compare outcomes between the two groups.

Statistical analysis was performed using appropriate statistical software. Continuous variables were expressed as mean ± standard deviation and compared using Student’s t-test. Categorical variables were expressed as frequencies and percentages and analyzed using the Chi-square test. A p-value of <0.05 was considered statistically significant, indicating meaningful differences between groups.

Patients were equally divided into two groups: Group A (LigaSure, n=40) and Group B (Conventional technique, n=40). The baseline characteristics were comparable between the two groups with no statistically significant differences. This indicates that both groups were well matched, allowing reliable comparison of surgical outcomes between LigaSure and conventional techniques. (Table 1).

Table 1: Baseline Characteristics of Study Population.

A statistically significant reduction in both operative time and blood loss was observed in the LigaSure group. This demonstrates improved intraoperative efficiency and superior haemostatic control compared to conventional techniques. (Table 2).

Table 2: Operative Time and Intraoperative Blood Loss

Patients in the LigaSure group had significantly reduced drain output and shorter hospital stay. This reflects reduced tissue trauma, better haemostasis, and faster postoperative recovery compared to conventional methods. (Table 3)

Table 3: Postoperative Drain Output and Hospital Stay

The overall complication rate was lower in the LigaSure group, particularly for hematoma and seroma formation. However, rates of hypocalcemia and recurrent laryngeal nerve injury were comparable between both groups, indicating that LigaSure improves safety mainly by reducing bleeding-related complications. (Table 4)

Table 4: Postoperative Complications

Group A demonstrated better overall surgical conditions with improved field visibility and faster recovery. This contributed to smoother dissection and reduced intraoperative difficulty, enhancing overall surgical performance. (Table 5).

Table 5: Overall Surgical Outcomes in both groups

Thyroidectomy is one of the most commonly performed endocrine surgical procedures, and meticulous haemostasis remains essential to minimize operative complications and improve postoperative recovery. The present study compared LigaSure-assisted thyroidectomy with conventional suture ligation techniques in 80 patients equally divided into two groups. Baseline demographic characteristics, including age, gender distribution, and thyroid pathology, were comparable between both groups, ensuring reliable evaluation of perioperative and postoperative outcomes.

The study demonstrated significantly improved operative efficiency in the LigaSure group. Mean operative time was considerably shorter in patients undergoing LigaSure-assisted thyroidectomy, with 34 (85%) patients completing surgery within the shorter operative duration range compared to 24 (60%) patients in the conventional group. Similar findings were reported by Bibi S et al.11 who observed significantly reduced operative time in LigaSure-assisted hemithyroidectomy, subtotal thyroidectomy, and total thyroidectomy compared to conventional techniques. Kadhim SH et al.12 also demonstrated significantly shorter surgical duration in the LigaSure group. Comparable observations were reported by Yousuf A et al.13 who found operative time to be 25–30 minutes shorter in LigaSure-assisted procedures compared to conventional thyroidectomy.

Intraoperative blood loss was significantly lower in the LigaSure group, with 32 (80%) patients experiencing minimal blood loss compared to 18 (45%) patients in the conventional group. Improved vessel sealing and precise haemostasis provided by LigaSure contributed to better surgical field visibility and easier dissection. Similar reductions in intraoperative blood loss were observed by Yaqoob M et al.14 who reported significantly lower intraoperative and postoperative bleeding in patients undergoing LigaSure-assisted subtotal thyroidectomy. El Hoseiny BA et al.15 and Altayb MA et al.16 also demonstrated reduced perioperative blood loss in the LigaSure group. Likewise, Raza A et al.17 concluded that LigaSure effectively minimized intraoperative bleeding while preserving recurrent laryngeal nerve function with minimal complications.

Postoperative recovery was notably better among patients treated with LigaSure. Reduced postoperative drain output was observed in 30 (75%) patients in Group A compared to 19 (47.5%) patients in the conventional group. Early discharge was achieved in 34 (85%) patients undergoing LigaSure-assisted thyroidectomy, whereas only 24 (60%) patients in the conventional group had shorter hospital stay. Similar findings were reported by Habash M et al.18 who demonstrated reduced hospital stay and postoperative blood loss in patients treated with LigaSure. El Hoseiny BA et al.15 also observed significantly shorter hospital stay in the LigaSure group, indicating faster postoperative recovery.

The incidence of postoperative complications was lower in the LigaSure group. Hematoma formation occurred in 1 (2.5%) patient compared to 4 (10%) patients in the conventional group, while seroma was observed in 2 (5%) and 6 (15%) patients respectively. Wound infection rates were also lower in the LigaSure group. These findings are consistent with observations by El Hoseiny BA et al.15 who reported lower rates of postoperative hematoma, seroma, and wound infection following LigaSure-assisted thyroidectomy. Habash M et al.18 similarly reported fewer postoperative complications and improved surgical safety with LigaSure.

Transient hypocalcemia and recurrent laryngeal nerve injury were comparable between both groups, indicating that LigaSure improves haemostatic efficiency without increasing nerve or parathyroid-related complications. Similar findings were reported by Kadhim SH et al.12 and Altayb MA et al.16 who demonstrated no significant difference in recurrent laryngeal nerve injury or postoperative hypocalcemia between LigaSure and conventional techniques. Yousuf A et al.13 also observed comparable postoperative complication rates despite improved operative efficiency with LigaSure. These findings support LigaSure as a safe and effective alternative to conventional thyroidectomy techniques, offering enhanced operative precision and improved postoperative recovery.

LigaSure is a safe and effective alternative to conventional techniques in thyroidectomy, offering significant advantages in reducing operative time, intraoperative blood loss, postoperative drain output, and duration of hospital stay. Improved haemostatic efficiency and superior surgical field visibility contribute to enhanced operative precision and smoother dissection. Although rates of complications such as transient hypocalcemia and recurrent laryngeal nerve injury remain comparable between the two techniques, bleeding-related complications are notably reduced with LigaSure.

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