Vascular clips versus ligatures in thyroid surgery—results of a multicenter randomized controlled trial (CLIVIT Trial)
| Autor: | Markus K, Diener, Christoph M, Seiler, Moritz, von Frankenberg, Kathleen, Rendel, Silke, Schüle, Katja, Maschuw, Stefan, Riedl, Jens C, Rückert, Christian, Eckmann, Uwe, Scharlau, Alexis, Ulrich, Thomas, Bruckner, Hanns-Peter, Knaebel, Matthias, Rothmund, Markus W, Büchler, Ralf, Konopke |
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| Rok vydání: | 2012 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Operative Time Blood Loss Surgical Germany medicine Paralysis Humans Elective surgery CLIPS Ligature Ligation computer.programming_language Analysis of Variance Goiter business.industry Length of Stay Middle Aged Vascular surgery Surgical Instruments Surgery Cardiac surgery Treatment Outcome Cardiothoracic surgery Recurrent Laryngeal Nerve Injuries Linear Models Thyroidectomy Female medicine.symptom business computer Abdominal surgery |
| Zdroj: | Langenbeck's Archives of Surgery. 397:1117-1126 |
| ISSN: | 1435-2451 1435-2443 |
| DOI: | 10.1007/s00423-012-0976-y |
| Popis: | New techniques using vascular clips or ultrasonically activated shears have been suggested to shorten operation time without compromising safety. The objective of the CLIVIT Trial was to compare ligatures with vascular clips for hemostasis in elective benign thyroid surgery. This multicenter, randomized, controlled, parallel group superiority trial was conducted in 13 German surgical centers. Patients scheduled for at least subtotal resection bilaterally were intraoperatively randomized. The primary endpoint was resection time. Secondary endpoints were the amount of postoperative bleeding, reoperation due to bleeding, wound infection, temporary (reversal within 12 months) and permanent (over 1 year) recurrent laryngeal nerve (RLN) paralysis, length of hospital stay, and safety. Registration: ISRCTN 96901396. Two hundred fifty patients were treated with ligatures and 241 with vascular clips. No differences in patients' baseline and surgical characteristics were observed. No difference was detected for mean resection time (clip 63.5 min ± 29.6, ligature 66.1 min ± 29.3, P = 0.258). Postoperative bleeding (mean 86 ml ± 93), reoperation due to bleeding (clips 4, ligature 2), wound infections (clips 4, ligature 4), postoperative hospital stay (mean 3.0 ± 1.9), and safety data also did not vary significantly. The rates of temporary and permanent RLN paralysis were 6.9 % (34/491) and 2.9 % (14/491), respectively. Not using a surgical drain (123 patients) was not associated with a higher rate of complications. Vascular clips did not reduce the resection time. However, a 2.9 % rate of permanent RLN paralysis is of concern. Drains in elective surgery may be of no benefit. |
| Databáze: | OpenAIRE |
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