Harmonic versus LigaSure for Flap Creation in Bilateral Axillary Breast Approach Thyroid Surgery

Purpose The bilateral axillary breast approach (BABA) is frequently utilized for remote access thyroid surgery. The first step in this surgical approach is to make a subcutaneous flap from the axilla to the neck, usually using a Harmonic ACE. Our institution has utilized LigaSure to create these flaps. This study reports comparative results with these 2 energy devices. Methods Medical data and video clips from 73 patients who underwent robotic BABA thyroid surgery were retrospectively reviewed. Flaps for BABA were created by first and second year endocrine fellows under the guidance of an experienced endocrine surgeon. There were no criteria for allocation to energy devices. Results Of the 73 patients, 31 and 42 underwent flap creation with the Harmonic ACE and LigaSure devices, respectively. Demographic characteristics were similar in the 2 groups. Mean time for flap creation was significantly shorter (33.46±8.33 vs. 38.27±7.14 min, P=0.012), and mean number of camera cleanings significantly lower (4.21±2.53 vs. 10.45±4.95, P<0.001), in the LigaSure group. Surgical site pain on day 2 was significantly lower in the LigaSure group. Postoperative bleeding and skin burn occurred only in patients in the Harmonic group. Conclusion LigaSure showed better performance than the Harmonic ACE device for BABA flap creation, as shown by time for flap creation, postoperative pain scores, and complications. Because this study was a small sized retrospective comparison, large randomized controlled trials are needed to confirm these results.