Bipolar Forceps: An Effective Alternative to Ultrasonic Scalpel in Open Thyroidectomy

With the increasing prevalence of early thyroid disease screening, the diagnosis and surgical rates of thyroid conditions are on the rise. For malignant tumors and large benign nodules that impair swallowing or breathing, unilateral or bilateral lobectomy remains the standard treatment^[1]. High-quality surgical instruments not only improve efficiency but also reduce complications.

In most Chinese hospitals, ultrasonic scalpels are commonly used in thyroid surgery. These devices utilize high-frequency vibrations to break protein bonds, enabling simultaneous tissue dissection and vessel sealing. Ultrasonic scalpels are flexible and can replace multiple traditional instruments—including electrocautery, scissors, vascular clamps, ligatures, and sutures—thereby shortening operative time and minimizing blood loss. Furthermore, they do not cause neuromuscular electrical stimulation. However, potential risks exist: the relatively bulky “scissor-style” blade of the ultrasonic scalpel may conduct excessive heat near delicate structures, such as the recurrent laryngeal nerve, increasing the risk of thermal injury and even permanent paralysis^[2].

Bipolar coagulation systems, originally used in neurosurgery, have shown excellent hemostatic precision in small vessels and are increasingly favored by thyroid surgeons ^[3]. ShouLiang-med’s bipolar forceps feature mirror-polished tips for superior conductivity, thermal efficiency, and anti-stick performance. Tip widths range from 0.25 mm to 2 mm, making them suitable for a wide range of procedures. In thyroid surgery, they allow for fine dissection near the recurrent laryngeal nerve and precise control of minor bleeding around nerve structures, with minimal thermal spread to adjacent tissues.

Preserving the parathyroid glands and their blood supply is another key challenge. Studies have shown a significantly lower incidence of postoperative hypocalcemia in patients treated with bipolar forceps compared to those treated with ultrasonic scalpels ^[4], likely due to the reduced collateral thermal damage and better vascular control. Moreover, postoperative drainage volumes were also lower in the bipolar group, possibly due to: (1) more precise coagulation of microvasculature, and (2) lower thermal tissue exudation compared to ultrasonic devices.

In conclusion, bipolar forceps offer a cost-effective solution with fine tips and limited thermal spread, significantly reducing the risk of injury to the recurrent laryngeal nerve and parathyroid glands. They present a viable alternative to ultrasonic scalpels in open thyroidectomy^[4].

References

[1] Thompson NW, Olsen WR, Hoffman GL. The continuing development of the technique of thyroidectomy [J]. Surgery, 1973, 73(6):913-927.

[2] Materazzi G, Caravaglios G, Matteucci V, et al． The impact of the

Harmonic FOCUSTM on complications in thyroid surgery: aprospective multicenter study[J]. Updates Surg, 2013, 65 (4): 295-299．

[3] Pniak T, Formánek M,Matousek P,et al. Bipolar thermofusion BiClamp 150 in thyroidectomy: a review of 1156 operations [J].Biomed Res Int, 2014, 2014: 707265．

[4]Ding S. Comparison of bipolar coagulation forceps and ultrasonic scalpel in thyroidectomy. Advances in Modern General Surgery of China, 2022; 25(08): 639–640+643.