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      A retrospective observational study of patients on maintenance hemodialysis receiving parathyroidectomy by ultrasonic scalpel

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          Abstract

          Background

          Secondary hyperparathyroidism (SHPT) remains a common complication in many patients on maintenance hemodialysis. Kidney Disease Improve Global Outcomes (KDIGO) 2017 guidelines suggest that parathyroidectomy (PTX) should be performed in severe SHPT patients with chronic kidney disease stage 3a-stage 5D. In the present study, we observed the efficacy of ultrasonic scalpel for PTX in SHPT patients on maintenance hemodialysis.

          Methods

          A total of 74 patients on maintenance hemodialysis who underwent PTX (34 with traditional electrocautery and 40 with an ultrasonic scalpel) were observed between August 2020 and August 2021 at Xiangyang Central Hospital (Hubei University of Arts and Science). Baseline demographic and clinic characteristics were collected pre- and post-PTX. Moreover, the postoperative complications and operation time were assessed between the two groups.

          Results

          The univariate analysis showed that there was no statistical significance in weight, dialysis duration, serum potassium, serum calcium, serum magnesium, alkaline phosphate, triglyceride, and intact parathyroid hormone (iPTH) before and after PTX between the two groups (P > 0.05). The operation time in the ultrasonic scalpel group was significantly decreased compared with the traditional electrocautery group (P < 0.05). Compared with the traditional electrocautery group, the drainage amount was significantly reduced in the ultrasonic scalpel group, and the number of days with drain and postoperative hospital stay were also remarkably decreased (P < 0.05).

          Conclusions

          The use of ultrasonic scalpel significantly reduced the operation time and postoperative hospital stay in patients on maintenance hemodialysis undergoing PTX.

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          Most cited references12

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          Improvement of mineral and bone metabolism markers is associated with better survival in haemodialysis patients: the COSMOS study.

          José Fernández Martín, Pablo Martínez-Camblor, María Dionisi … (2015)
          Abnormalities in serum phosphorus, calcium and parathyroid hormone (PTH) have been associated with poor survival in haemodialysis patients. This COSMOS (Current management Of Secondary hyperparathyroidism: a Multicentre Observational Study) analysis assesses the association of high and low serum phosphorus, calcium and PTH with a relative risk of mortality. Furthermore, the impact of changes in these parameters on the relative risk of mortality throughout the 3-year follow-up has been investigated.
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            CKD-mineral and bone disorder and risk of death and cardiovascular hospitalization in patients on hemodialysis.

            Geoffrey A Block, Ryan Kilpatrick, Kimberly A. Lowe … (2013)
            Parathyroid hormone, calcium, and phosphate have been independently associated with cardiovascular event risk. Because these parameters may be on the same causal pathway and have been proposed as quality measures, an integrated approach to estimating event risks is needed.
            Article 0 comments Cited 29 times – based on 0 reviews     Review now
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              Prevention and management of bleeding in thyroid surgery

              Gabriele Materazzi, Carlo Enrico Ambrosini, Lorenzo Fregoli … (2017)
              Post-thyroidectomy neck hematoma represents a major concern for surgeons because it can result in severe and even life-threatening complications. In fact, postoperative hemorrhage may result in airway compression and respiratory distress, and therefore, effective hemostasis is an important goal in thyroid surgery. Postoperative hematoma occurs at a rate of approximately 0.1% to 1.1%. Almost all cases occur in the first 6 h after surgery and can be the result of several surgeon or patient factors. For many years the clamp-and-tie technique has been the most common way to divide the main vascular pedicles of the thyroid gland. Alternatively, bipolar electrocautery has been used for only very small vessels. Other hemostatic systems have been introduced and proved to be potentially very useful in neck surgery and, in particular, for thyroid surgery. This new class of instruments is generally known as “energy devices” because they use different forms of energy, such as advanced bipolar (LigaSure TM Small Jaw Medtronic, Covidien product, Mineapolis, MN, USA) and ultrasound (Harmonic Focus; Ethicon, Johnson and Johnson, Cincinnati, OH, USA), and hybrid devices that join these two technologies (Thunderbeat by Olympus, Japan). Although they all generate a significant elevation of temperature in the tissues, as in any form of energy, the temperatures reached by these instruments are never as high as the standard monopolar electrocautery. For small bleeding very close to critical structures, where energy devices are too dangerous to be used and clamp and tie is not possible, several studies have assessed the use of adjunctive hemostatic agents. In conclusion, all energy devices have been shown to significantly decrease operative times without increasing costs or complications. Adjunctive hemostatic agents have shown equivalent differences when added to standard methods from a clinically significant perspective.
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                Author and article information

                Contributors
                Zhao Gao: gaozhao1648@163.com
                Hai Yuan: yh122@hotmail.com
                Journal
                Journal ID (nlm-ta): BMC Surg
                Journal ID (iso-abbrev): BMC Surg
                Title: BMC Surgery
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1471-2482
                Publication date (Electronic): 18 May 2022
                Publication date PMC-release: 18 May 2022
                Publication date Collection: 2022
                Volume: 22
                Electronic Location Identifier: 192
                Affiliations
                GRID grid.412979.0, ISNI 0000 0004 1759 225X, Department of Nephrology, Xiangyang Central Hospital, , Hubei University of Arts and Science, ; Xiangyang, Hubei China
                Article
                Publisher ID: 1634
                DOI: 10.1186/s12893-022-01634-8
                PMC ID: 9118740
                SO-VID: 652eb3b5-3408-4eac-af76-18c600853283
                Copyright © © The Author(s) 2022
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                Date received : 29 November 2021
                Date accepted : 3 May 2022
                Funding
                Funded by: the Natural Science Foundation of Hubei Province
                Award ID: 2019CFB392
                Award Recipient :
                Funded by: Hubei Province Health and Family Planning Scientific Research Project
                Award ID: WJ2019Q018
                Award Recipient :
                Categories
                Subject: Research
                Custom metadata
                issue-copyright-statement © The Author(s) 2022

                ScienceOpen disciplines: Surgery
                Keywords: haemodialysis,chronic kidney disease,secondary hyperparathyroidism,parathyroidectomy,ultrasonic scalpel
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: haemodialysis, chronic kidney disease, secondary hyperparathyroidism, parathyroidectomy, ultrasonic scalpel

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