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Author's Response: A Prospective, Randomized, Controlled Comparative Study of Three Energy Devices in Open Thyroid Surgery: Thunderbeat, Harmonic, and Ligasure

Purpose: Energy devices, such as Harmonic Focus Plus (Ethicon; ultrasonic scalpel; Harmonic) and Ligasure Small Jaw (Covidien; bipolar sealer; Ligasure) are widely used in thyroid surgery as substitutes for Bovie (electrocautery) and sutures. They reduce operation time and peri-operative complications. Thunderbeat Open Fine Jaw (Olympus; Thunderbeat) is a recently developed energy device, which combines the functions of both ultrasonic scalpel and bipolar sealer. We prospectively evaluated the safety and feasibility of Thunderbeat during open thyroidectomy compared with Harmonic and Ligasure. Methods: From September to November 2016, patients with papillary thyroid cancer or benign thyroid disease who underwent unilateral or bilateral thyroidectomy at Samsung Medical Center were enrolled. Thyroidectomies were performed by a single surgeon who specializes in endocrine surgery and is experienced in using energy devices. The patients were randomly allocated to one of the 3 groups according to the energy device used during the operation: Harmonic, Ligasure, and Thunderbeat group. Results: No significant differences were detected among the 3 groups in intra-operative bleeding, drainage amount, incidence of transient hypocalcemia, and transient vocal cord palsy. The surgical time for thyroidectomy in the T group was shorter than in the other 2 groups (P=0.031). However, the H group showed reduced surgical time for central lymph node dissection. Conclusion: Among the 3 energy devices, Thunderbeat and Harmonic shortened the surgical time for thyroidectomy and central lymph node dissection, respectively. However, each energy device has its own strengths and weaknesses, and we recommend the selection of devices based on the respective features.