Phd in ADVANCED SURGICAL TECHNOLOGIES

Thesis title: Harmonic Focus, Ligasure Small Jaw e Thunderbeat Open Fine Jaw negli interventi di tiroidectomia totale in pazienti affetti da carcinoma differenziato della tiroide: analisi comparativa degli outcomes chirurgici.

Background: Thyroid carcinoma is the most common malignancy of the endocrine system, accounting for approximately 4% of all new cancer diagnoses. Surgery represents the mainstay of treatment for patients affected by this disease, making thyroidectomy the most frequently performed procedure in endocrine surgery. Among the numerous technological innovations introduced in thyroid surgery in recent decades, the use of energy-based devices (EBDs) has allowed to ensure adequate hemostasis control and, by facilitating surgical maneuvers, to reduce operative time. Materials and Methods: The aim of this prospective randomized study was to compare the use of Harmonic Focus (Group A), Ligasure Small Jaw (Group B), and Thunderbeat Open Fine Jaw (Group C) in total thyroidectomy performed for differentiated thyroid carcinoma, in terms of surgical outcomes. Results: A total of 150 patients underwent total thyroidectomy for differentiated thyroid carcinoma: 50 in Group A (Harmonic Focus), 50 in Group B (Ligasure Small Jaw), and 50 in Group C (Thunderbeat Open Fine Jaw). Demographic data and histopathological findings were homogeneous among the three groups, with no statistically significant differences. No significant differences were observed among the groups regarding complication rates, hospital stay, drainage output, or the need for additional analgesic therapy. The difference in operative time was statistically significant between Group C and both Group A (p ≈ 0.0047) and Group B (p ≈ 0.02). Another parameter reaching statistical significance was the postoperative pain (VAS score), with significant differences between Group A and Group C (p = 0.002) and between Group B and Group C (p = 0.00002). Conclusions: In our study, all devices proved to be safe and effective for sutureless total thyroidectomy, with comparable complication rates among the three groups. However, the Thunderbeat device demonstrated shorter operative times and was associated with lower postoperative pain. Despite the limitations of our study, the results provide valuable evidence in a relatively underexplored field and may serve as a basis for future research aimed at expanding these findings.