Letter to the Editor: A Prospective, Randomized, Controlled Comparative Study of Three Energy Devices in Open Thyroid Surgery: Thunderbeat, Harmonic, and Ligasure

Abstract

We read with interest “A Prospective, Randomized, Controlled Comparative Study of Three Energy Devices in Open Thyroid Surgery: Thunderbeat, Harmonic, and Ligasure” by Back et al. (1). This is a randomized study by a single surgeon which has added to the existing literature on hemostatic devices, analyzing the role of each device, their strengths and weaknesses. The role of thunderbeat in reducing the time of central compartment lymph node dissection with similar intraoperative and postoperative outcomes can be of much help in central dissections where the inferior parathyroid gland and the recurrent laryngeal nerve can be at risk (2). We also agree with the authors that individualizing the best device for that particular procedure can help in much-desired outcomes. We have a few queries which may interest future readers. What was the cost difference incurred in using these instruments, since in a developing country money can be a determining factor influencing the usage of such devices? Did the surgeon tie the superior pole vessels and then use the hemostatic device? If only a hemostatic device was used without any suture, did the surgeon use a double seal or triple seal technique? For lymphatic vessel sealing, which hemostatic device do the authors prefer?