Author's Response: A Prospective, Randomized, Controlled Comparative Study of Three Energy Devices in Open Thyroid Surgery: Thunderbeat, Harmonic, and Ligasure

Dear Prof. Sabaretnam Mayilvaganan,

Thank you for the comments and questions (1). Let me answer your questions individually.

In Korea, the 3 energy devices have the same price. We charge about 80% of the total price regardless of tumor nature. Therefore, patients pay approximately 470,000 Korean won (about 400 USD).

Dealing with blood vessels is the decision of the surgeon. Usually, the thyroid gland is feed by small to medium-sized vessel, and such an energy device is sufficient for control of bleeding in most cases. However, when thyroid glands are associated with large vessels, such as in Graves' disease, we prefer to use suture or tie ligation rather than energy devices for secure control of blood vessels. In some cases, we use both an energy device and suture/tie ligation together. As you mentioned, we would like to perform a multi-point sealing technique using only an energy device.

For secure ligation of lymphatic ducts, most surgeons prefer suture, tie material, or surgical clip to energy devices. We also suggest suture or tie ligation to energy devices because lymphatic ducts have a such a thin wall. I hope this reply is helpful for your future work.