The role of LigaSure™ and Harmonic Scalpel in the preservation of recurrent laryngeal nerve during thyroidectomy

Ann R Coll Surg Engl. 2022 May;104(5):324-329. doi: 10.1308/rcsann.2021.0125. Epub 2021 Aug 20.


Introduction: Transient or permanent damage to the recurrent laryngeal nerve (RLN) during thyroidectomy is of paramount importance for patient quality of life. The aim of this study is to systematically review the literature concerning the role of the most popular energy-based vessel-sealing devices (LigaSure™ (LS) and Harmonic Scalpel (HS)) in preservation of the RLN during thyroidectomy. The safety and inferiority or superiority of LS and HS compared with conventional haemostatic techniques are highlighted.

Methods: A systematic search of the literature was performed. Clinical trials, prospective and retrospective studies that significantly compared the use of LS and HS with conventional haemostasis regarding the postoperative incidence of RLN palsy were included.

Findings: The search resulted in 43 studies, including 17,953 patients treated using energy-based devices or conventional haemostatic methods. Concerning the incidence of RLN palsy, 40 studies showed no significant difference between the energy-based device and conventional groups, whereas two studies demonstrated a significant superiority in performance for LS and HS compared with conventional haemostasis. Only one study exhibited significant inferiority of LS and HS compared with conventional methods. No statistical relationship was observed between energy-based devices and conventional techniques regarding permanent damage to the RLN.

Conclusion: The performance of both LS and HS shows no inferiority compared with conventional haemostatic techniques, regarding damage to the laryngeal nerve. Further well-designed studies are needed to investigate their potential benefit in preservation of the RLN.

Keywords: Energy-based devices; Harmonic; LigaSure™; Recurrent laryngeal nerve; Thyroidectomy.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Humans
  • Prospective Studies
  • Quality of Life
  • Recurrent Laryngeal Nerve
  • Retrospective Studies
  • Thyroidectomy* / adverse effects
  • Thyroidectomy* / methods
  • Vocal Cord Paralysis* / epidemiology
  • Vocal Cord Paralysis* / etiology
  • Vocal Cord Paralysis* / prevention & control