Hemostasis during thyroidectomy in the era of energy-based devices: an update

INTRODUCTION: Hemostasis is the cornerstone of any surgical operation. Vascularization of the thyroid is abundant; therefore, scrupulous hemostasis is fundamental to sidestep severe complications. The aim of this article is not only an overview of the already described knowledge on energy- based devices but to focus on innovation, besides updated data concerning hemostasis.EVIDENCE ACQUISITION: An evaluation of relevant papers in PubMed, published through December 2020.EVIDENCE SYNTHESIS: Thorough hemostasis is necessary to prevent bleeding in the operating field for clear visualization of anatomical structures to minimize complications, including primarily recurrent laryngeal nerve paralysis and hypoparathyroidism. Conventionally, the clamp-and-tie technique used for hemostasis is the gold standard for thyroid surgery. Over recent decades, technological advances in surgical methods, as well as more minimally invasive approaches have led to the use of instruments that might significantly reduce the risks of intraoperative trauma. These novel instruments are referred to as “energy-based devices,” because different forms of energy are used, mainly radiofrequency or ultrasound energy or a combination of these modalities.CONCLUSIONS: The application of energy-based devices facilitates dissection and coagulation with minimal bleeding and shortens the operation time. It should be highlighted that safe and appropriate use of these instruments is essential to optimize their benefits to both patients and surgeons.