Electrothermal bipolar vessel sealing system is a safe and time-saving alternative to classic suture a ligation in total thyroidectomy

Background. Total thyroidectomy is associated with minimal morbidity. The electrothermal bipolar vessel sealing system is an adjunct to the surgical technique, recently made available to thyroid surgery. Methods. This is a prospective randomized trial of total thyroidectomies performed in single unit from July 2003 to May 2004. Patients were randomly assigned in two groups: group A (n = 90), total thyroidectomy with the classic suture ligation technique; and group B (n = 94), total thyroidectomy with the use of the electrothermal bipolar vessel sealing system. Results. Operative time was significantly reduced in group B by 14 minutes (mean difference, 14.3 +/- 4.2 minutes, 95% Cl, 5.88-22.6 minutes). No statistically significant differences were found in postoperative complications, postoperative serum calcium measurements, or hospital stay between the two groups. Conclusions. The electrothermal bipolar vessel sealing system is a safe and useful, time-saving adjunct for total thyroidectomy. (c) 2005 Wiley Periodicals, Inc

Intra-arterial bolus octreotide administration during Whipple procedure in patients with fragile pancreas: A novel technique for safer pancreaticojejunostomy

Background and Objectives: Leakage from the pancreaticojujenostomy is the most serious complication of Whipple. Pancreatic fistula rate is higher in cases of fragile pancreas often seen in duodenal carcinomas and carcinomas of the ampulla of Vater. Octreotide administration has been used for the prevention of fistula formation through the subcutaneous route. Due to its physiologic effects to the pancreatic parenchyma the intra-arterial administration of octreotide could provide tissue hardening that allows for a technically easier anastomosis while maintaining its protective role for fistula formation. Methods: Octreotide was injected directly into the distal part of the gastroduodenal artery (GDA) in four patients undergoing Whipple for histologically proven periampullary cancer. Results: Tissue hardening after octreotide administration was evident not only in surgeons’ hands but in the intra-operative ultrasound as well. The three patients were discharged on day 9, 11, and 13; they had an uneventful postoperative course, while one patient had a minor bile leak from the choledojejunal anastomosis and was discharged on day 22. Conclusions: The intra-arterial administration of octreotide during Whipple is a safe procedure and provides tissue hardening thus making the performance of the anastomosis technically easier. The actual benefit in terms of morbidity, mortality, and fistula rate are to be further evaluated. (C) 2005 Wiley-Liss, Inc