A Comparative Analysis of Hypocalcemia Incidence in Patients Undergoing Thyroidectomy: LigaSure Versus Conventional Ligation of Vessels by Knot Tying: Hypocalcemia in Thyroidectomy Patients: LigaSure Versus Conventional Ligation

Zain Himayoun; Hunza Binte Ather; Mudassar Malik; Numan Pervaiz; Iftikhar Ahmed; Usman Ali Rahman

doi:10.54393/pjhs.v6i11.3114

Authors

Zain Himayoun Department of General Surgery, Gulab Devi Hospital, Lahore, Pakistan
Hunza Binte Ather Department of General Surgery, Gulab Devi Hospital, Lahore, Pakistan
Mudassar Malik Department of General Surgery, Gulab Devi Hospital, Lahore, Pakistan
Numan Pervaiz Department of General Surgery, Gulab Devi Hospital, Lahore, Pakistan
Iftikhar Ahmed Department of General Surgery, Gulab Devi Hospital, Lahore, Pakistan
Usman Ali Rahman Department of General Surgery, Gulab Devi Hospital, Lahore, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v6i11.3114

Keywords:

Thyroidectomy, Hypocalcemia, LigaSure, Knot Tying, Randomized Controlled Trial

Abstract

Hypocalcemia is a frequent postoperative complication after total thyroidectomy. It usually arises from unintentional injury to the parathyroid glands or disruption of their blood supply during surgery. Advanced vessel sealing technologies like LigaSure aim to lower this risk by ensuring greater surgical precision and reducing thermal injury to adjacent structures, particularly the parathyroid glands. Objectives: To compare the incidence of postoperative hypocalcemia between LigaSure and conventional knot-tying techniques in total thyroidectomy patients. Methods: A randomized controlled trial was conducted at the Surgical Department of Gulab Devi Hospital, Lahore, from April 2024 to March 2025. Seventy-six patients who underwent total thyroidectomy for benign thyroid disease were randomly allocated to the LigaSure (n=38) and conventional knot-tying (n=38) groups. Serum calcium levels were measured preoperatively and at 24/48 hours postoperatively. For statistical analysis, SPSS v24 was used, and non-parametric tests like the Mann-Whitney U and chi-square tests were used. Results: Incidence of hypocalcemia was higher in the LigaSure group (10.5%) as compared to the conventional group (7.9%), but of no statistical significance (p=0.692). Conclusions: Both techniques demonstrated comparable safety profiles with no statistically significant differences in postoperative outcomes. LigaSure offers a comparable alternative to conventional methods of vessel sealing/ligation.

References

Salamat ZH, Majid M, Ali L, Ali HA, Yasin T. Comparison of Total Thyroidectomy with Ligasure Small Jaw Device and Harmonic Scalpel. Pakistan Armed Forces Medical Journal. 2023 Jun; 73(3): 720. doi: 10.51253/pafmj.v73i3.7230. DOI: https://doi.org/10.51253/pafmj.v73i3.7230

Alqahtani SM, Alatawi AS, Alalawi YS, Alatawi AS, Alalawi Y. Post-Thyroidectomy Hypocalcemia: A Single-Center Experience. Cureus. 2021 Nov; 13(11). doi: 10.7759/cureus.20006. DOI: https://doi.org/10.7759/cureus.20006

Chahardahmasumi E, Salehidoost R, Amini M, Aminorroaya A, Rezvanian H, Kachooei A et al. Assessment of the Early and Late Complication After Thyroidectomy. Advanced Biomedical Research. 2019 Jan; 8(1): 14. doi: 10.4103/abr.abr_3_19. DOI: https://doi.org/10.4103/abr.abr_3_19

Lalitha JJ, Ramalingam N, Rajan R, Riju J, Paulose AA, Michael RC et al. Predictors of Hypocalcaemia and Hypoparathyroidism in Patients Undergoing Thyroidectomy for Benign and Malignant Pathologies. Endocrine Oncology. 2024 Jan; 4(1). doi: 10.1530/EO-24-0022. DOI: https://doi.org/10.1530/EO-24-0022

Nemeth ZH, Kong K, Hwang R, Soliman SS, Rolandelli RH. Vessel Sealant Devices in Thyroidectomies: An ACS-NSQIP Study. Southern Medical Journal. 2022 May; 115(5): 304-9. doi: 10.14423/SMJ.0000000000001364. DOI: https://doi.org/10.14423/SMJ.0000000000001364

Lee YH, Liu Z, Zheng L, Qiu J, Sang J, Guan W. The Rate of Postoperative Decline in Parathyroid Hormone Levels Can Predict Symptomatic Hypocalcemia Following Thyroid Cancer Surgery with Neck Lymph Node Dissection. Nutrition and Cancer. 2025 Jan; 77(1): 1-8. doi: 10.1080/01635581.2024.2401179. DOI: https://doi.org/10.1080/01635581.2024.2401179

İnanç ÖF, Çetin K, Tosun Y, Küçük HF. Risk Factors of Hypocalcemia After Total Thyroidectomy. A High Volume Center Experience. Frontiers in Endocrinology. 2025 May; 16: 1538993. doi: 10.3389/fendo.2025.1538993. DOI: https://doi.org/10.3389/fendo.2025.1538993

Koimtzis GD, Stefanopoulos L, Giannoulis K, Papavramidis TS. What Are the Real Rates of Temporary Hypoparathyroidism Following Thyroidectomy? It Is a Matter of Definition: A Systematic Review. Endocrine. 2021 Jul; 73(1): 1-7. doi: 10.1007/s12020-021-02663-8. DOI: https://doi.org/10.1007/s12020-021-02663-8

Altayb MA, Helmy AA, Marsis AR. Comparative Study between Ligasure and Conventional Vessel Ligation in Thyroidectomy “Randomized-Controlled Study “. The Egyptian Journal of Hospital Medicine. 2022 Jul; 88(1): 3464-9. doi: 10.21608/ejhm.2022.248785. DOI: https://doi.org/10.21608/ejhm.2022.248785

Malik S, Ibrahim T, Morgan J, Law N. Is an Energy-Based Vessel Sealing Device More Effective Than the Conventional Clamping and Knot Tying Technique in Thyroid Surgery? A Quasi-Experimental Study. Pakistan Armed Forces Medical Journal. 2022; 72(2): 539-542. doi: 10.51253/pafmj.v72i2.5331. DOI: https://doi.org/10.51253/pafmj.v72i2.5331

Mulita F, Liolis E, Tchabashvili L, Tasios K, Papanikos V, Tsilivigkos C et al. Comparison of Postoperative Complications Using Harmonic Scalpel and Ligasure in Thyroid Surgery. Albanian Journal of Trauma and Emergency Surgery. 2024 Jan; 8(1): 1331-4. doi: 10.32391/ajtes.v8i1.362. DOI: https://doi.org/10.32391/ajtes.v8i1.362

Akgun IE, Unlu MT, Aygun N, Kostek M, Tufan AE, Yanar C et al. The Reality of Hypoparathyroidism After Thyroidectomy: Which Risk Factors Are Effective? Single-Center Study. Sisli Etfal Hastanesi Tip Bulteni. 2022 Jun; 56: 262-9. doi: 10.14744/SEMB.2022.24356. DOI: https://doi.org/10.14744/SEMB.2022.24356

Antakia R, Edafe O, Uttley L, Balasubramanian SP. Effectiveness of Preventive and Other Surgical Measures On Hypocalcemia Following Bilateral Thyroid Surgery: A Systematic Review and Meta-Analysis. Thyroid. 2015 Jan; 25(1): 95-106. doi: 10.1089/thy.2014.0101. DOI: https://doi.org/10.1089/thy.2014.0101

Montori G, Botteri E, Ortenzi M, Gerardi C, Allocati E, Giordano A et al. Systematic Review and Meta-Analysis of the Use of High-Energy Devices for Thyroid Surgery. Langenbeck's Archives of Surgery. 2024 Jul; 409(1): 217. doi: 10.1007/s00423-024-03399-5. DOI: https://doi.org/10.1007/s00423-024-03399-5

Olasehinde O, Owojuyigbe A, Adeyemo A, Mosanya A, Aaron O, Wuraola F et al. Use of Energy Device in General Surgical Operations: Impact on Peri-Operative Outcomes. BioMed Central Surgery. 2022 Mar; 22(1): 90. doi: 10.1186/s12893-022-01540-z. DOI: https://doi.org/10.1186/s12893-022-01540-z

Wang JJ, Huang TY, Wu CW, Lin YC, Tseng HY, Liu CH et al. Improving Voice Outcomes After Thyroid Surgery–Review of Safety Parameters for Using Energy-Based Devices Near the Recurrent Laryngeal Nerve. Frontiers in Endocrinology. 2021 Nov; 12: 793431. doi: 10.3389/fendo.2021.793431. DOI: https://doi.org/10.3389/fendo.2021.793431

Bhettani MK, Rehman M, Khan MS, Altaf HN, Khan KH, Farooqui F et al. Safety and Cost-Effectiveness of Ligasure® in Total Thyroidectomy in Comparison with Conventional Suture Tie Technique. Cureus. 2019 Dec; 11(12). doi: 10.7759/cureus.6368. DOI: https://doi.org/10.7759/cureus.6368

Lorente-Poch L, Sancho JJ, Ruiz S, Sitges-Serra A. Importance of in Situ Preservation of Parathyroid Glands During Total Thyroidectomy. Journal of British Surgery. 2015 Mar; 102(4): 359-67. doi: 10.1002/bjs.9676. DOI: https://doi.org/10.1002/bjs.9676

Pace‐Asciak P, Russell J, Solorzano C, Berber E, Singer M, Shaha AR et al. The Utility of Parathyroid Auto-Fluorescence as an Adjunct in Thyroid and Parathyroid Surgery 2023. Head and Neck. 2023 Dec; 45(12): 3157-67. doi: 10.1002/hed.27538. DOI: https://doi.org/10.1002/hed.27538

Yousuf A, Shamim A, Hannan A, Sideeq K, Qazi SM. Thyroid Surgery Outcome Benefits with Energy Based Devices Over Conventional Technique: A Comparative Study. Journal of Head and Neck Physicians and Surgeons. 2023 Jan; 11(1): 35-8. doi: 10.4103/jhnps.jhnps_79_22. DOI: https://doi.org/10.4103/jhnps.jhnps_79_22