World Journal of Endocrine Surgery

Register      Login

VOLUME 6 , ISSUE 3 ( September-December, 2014 ) > List of Articles


Safety and Cost Efficiency in Thyroid Surgery

Ian R Gough, Oh Thomas Young-Chul

Citation Information : Gough IR, Young-Chul OT. Safety and Cost Efficiency in Thyroid Surgery. World J Endoc Surg 2014; 6 (3):101-106.

DOI: 10.5005/jp-journals-10002-1147

Published Online: 01-04-2008

Copyright Statement:  Copyright © 2014; The Author(s).



Recent developments in technology aim to reduce operative time and improve safety, albeit at significant cost. Thyroidectomy is a common procedure worldwide and an assessment of costefficiency is important.

Materials and methods

An audit of prospectively collected data on all thyroidectomies performed by a single endocrine surgeon at two private hospitals from 2009 to 2013. The technique was a conventional open dissection emphasizing capsular dissection with ligature and ligaclip and without intraoperative nerve monitoring (IONM). The operative duration was compared to those reported in literature with the use of vessel sealing devices (VSDs). Estimated time-dependent operating theater cost was used to determine the amount of time saving required by VSDs to match the costefficiency of our technique.


There were 503 thyroidectomies with the expected mix of pathologies. There were zero permanent recurrent laryngeal nerve injuries (0.5% temporary, 746 nerves at risk), 0.6% permanent hypoparathyroidism (19.5% temporary, 308 completion and total thyroidectomies) and 0.6% hematoma. These outcomes compare favorably with published best practice. The median skin to skin operating time was 59 minutes for total and 35 minutes for hemithyroidectomies which are shorter than those reported with VSDs. The minimum time reduction required by VSDs to match the costefficiency of our technique was 27 minutes for hemithyroidectomy and 15 minutes for total thyroidectomy, which are longer than those reported in the literature.


Despite the current popularity of VSDs and the promotion of IONM, their routine use may not be justified. Technique is more important than technology.

How to cite this article

Young-Chul OT, Gough I. Safety and Cost Efficiency in Thyroid Surgery. World J Endoc Surg 2014;6(3):101-106.

PDF Share
  1. Total thyroidectomy for management of thyroid disease. World J Surg 2000;24:962-965.
  2. Total thyroidectomy: the evolution of surgical technique. ANZ J Surg 2003;73:761-768.
  3. Total thyroidectomy: indications, technique and training. Aust NZ J Surg 1992;62:87-89.
  4. Volumetric analysis of thyroid lobes by real-time ultrasound (author's transl). Dtsch Med Wochenschr 1981;106:1338-1340.
  5. The British Association of Endocrine and Thyroid Surgeons: Fourth National Audit Report 2012.
  6. Complications of thyroid surgery: analysis of a multicentric study on 14,934 patients operated on in Italy over 5 years. World J Surg 2004;28:271-276.
  7. Fifteen years’ experience in thyroid surgery. Ann R Coll Surg Engl 2010;92:541-547.
  8. Postoperative hypocalcemia: the difference a definition makes. Head Neck 2010; 32:279-283.
  9. Post thyroidectomy complications: the Hyderabad experience. J Ayub Med Coll Abbottabad 2010;22:65-68.
  10. Recurrent laryngeal nerve monitoring versus identification alone on post-thyroidectomy true vocal fold palsy: a meta-analysis. Laryngoscope 2011;121:1009-1017.
  11. Electrothermal bipolar vessel sealing system is a safe and time-saving alternative to classic suture ligation in total thyroidectomy. Head Neck 2005;27:959-962.
  12. Thyroid surgery: use of the Ligasure vessel sealing system versus conventional knot tying. Int J Surg 2008;6:323-327.
  13. What does one minute of operating room time cost? J Clin Anes 2010;22:233-236.
  14. Sutureless total thyroidectomy: a safe and cost-effective alternative. ANZ J Surg 2011;81:510-514.
  15. Comparison of Ligasure vessel sealing system, harmonic scalpel, and conventional hemostasis in total thyroidectomy. Otolaryngol Head Neck Surg 2009;141:496-501.
  16. Ligasure in total thyroidectomy. Surg Today 2008;38:495-498.
  17. Ligasure precise use in thyroid operations: a comparison with the conventional method. Eur Surg 2007;39:54-56.
  18. Use of a diathermy system in thyroid surgery. Arch Surg 2004;139:997-1000.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.