Application of LigaSure Technology in Thyroid Surgery

Abstract

The incidence of nodular forms of goitre, compression syndrome in particular, as well as thyroid oncopathology is steadily growing. The number of patients with diffuse toxic goitre and functional autonomy of nodular forms of goitre exhibits no tendency toward reduction. Thyroid surgery remains one of the major and most effective methods of treatment. Parathyroid glands and laryngeal nerves are located close to large branches of the thyroid arteries; therefore, thyroid surgery should be performed in a dry operative field. The objective of the research was to assess the efficacy of the LigaSure technology in the formation of reliable homeostasis as well as to provide morphological basis for blood clot quality and morphofunctional state of the thyroid parenchyma after hemithyroidectomy. Materials and methods. The results of surgical treatment of 100 patients with nodular and toxic forms of goitre being treated in the surgical department of the Ternopil Municipal Emergency Hospital during 2011-2012 were compared with the results of surgical treatment of 200 patients with similar pathology who underwent surgical treatment during 2014-2016. According to the in-patient medical records, in patients operated on during 2011-2012 to achieve homeostasis the traditional ligature method was used; the length of surgical access was 6-8 cm. However, to achieve homeostasis in patients operated on during 2014-2016 the LigaSure device was used during surgery; the length of surgical access was 2.5-3 cm. The removed part of the thyroid gland was sent for morphological examination. The thyroid tissue was fixed in a 10% neutral formalin solution to be studied macro-and microscopically. A 1.0x0.5-cm fragment of the thyroid tissue was dissected out from three areas: the first fragment was dissected out from the area of the impact of radio-frequency current; the second fragment was dissected out in the perifocal area 0.5 cm from the electrocoagulation area, and the third one was dissected out 0.8-1.0 cm from the electrocoagulation area. Dewaxed sections were stained with haematoxylin, eosin as well as with Hart and Mallory’s fuchselin. Histological preparations were studied using the SEOSCAN and Lumam P-8 microscopes at different magnifications. Results. Histological study revealed local coagulative necrosis in the area of the impact of LigaSure radio-frequency current. The contours of the follicles without coloured structures, which were saturated with haemolytic erythrocytes, indicated necrosis. The thyrocyte cytoplasm and intercellular tissue were eosinophilic; the nuclei were not identified. In the lumen of intraorganic blood vessels, there was formed homogeneous agglutinative thrombus tightly adhering to the vascular wall indicating the formation of reliable and high-quality homeostasis in the area of direct effect of radio-frequency current. In the perifocal area there were the signs of the adaptive processes on the background of pronounced microcirculatory disturbances. Changes in thyrocytes manifested themselves as necrotic and dystrophic swelling and enlightenment of the cytoplasm. Clinically, these changes may manifest themselves as an increase in the secretory function of the thyroid gland in the particular area. Changes being typical to chronic manifestations of nodular goitre were found in the areas more distant from coagulative necrosis. The thyroid parenchyma was represented by clusters of large and small follicles separated by connective tissue interlayers. Conclusions. The application of the LigaSure technology in surgical treatment of the thyroid gland improves the quality of surgical interventions due to a decrease in intraoperative blood loss, duration of surgery as well as postoperative in-patient treatment. In addition, the LigaSure technology provides better surgical access, thereby improving cosmetic effect. Morphologic changes in the thyroid gland due to the effect of radio-frequency current were distance-dependent: in the area of direct effect of radio-frequency current coagulative necrosis developed; in the perifocal area intensified secretory response of the thyroid tissue to the extreme factor occurred; in distant areas the typical structure of the nodular goitre with the signs of disturbed microcirculation was found.

Keywords

• thyroid gland
• surgical treatment
• electrocoagulation