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.

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.

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It is important that all these remnants are objectively looked for and removed during surgery in order to prevent recurrences.

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