Comparative Effectiveness and Safety of Energy Devices for Thyroidectomy: An Outcome‐Specific Network Meta‐Analysis of Randomized Controlled Trials
Do Hyun Kim, David W. Jang, Se Hwan HwangABSTRACT
Background
We performed an outcome‐specific network meta‐analysis comparing contemporary energy devices in thyroidectomy.
Methods
Randomized controlled trials comparing conventional hemostasis with Harmonic, LigaSure, Thunderbeat, or other advanced energy devices during thyroidectomy were included. Frequentist random‐effects network meta‐analyses were performed per outcome, with treatments ranked by P‐scores and consistency assessed via design‐by‐treatment interaction and node‐splitting analyses.
Results
Compared to conventional hemostasis, Harmonic significantly reduced operative time (SMD, −1.88), blood loss (SMD, −2.29), drainage volume (SMD, −1.77), hospital stay (SMD, −0.74), transient hypocalcemia (OR, 0.61), transient recurrent laryngeal nerve palsy (OR, 0.63), and postoperative bleeding (OR, 0.56). LigaSure improved operative efficiency but showed less consistent recovery and safety benefits. Harmonic ranked highest across most outcomes.
Conclusions
Harmonic showed the most favorable relative effects across the evaluated outcomes. However, these findings do not establish overall device superiority; selection should consider absolute benefits and device‐specific characteristics.