Comparative Effectiveness of Contemporary Hemostatic Devices in Thyroidectomy: A Network Meta‐Analysis of Surgical Safety and Operative Efficiency

ABSTRACT Background We performed a network meta‐analysis to compare contemporary hemostatic techniques used in thyroid surgery. Methods We systematically reviewed randomized controlled trials comparing conventional hemostasis, advanced bipolar devices, ultrasonic devices, Thunderbeat, and stapling devices. Primary outcomes were postoperative complications; secondary outcomes included intraoperative blood loss, postoperative drain volume, operative time, postoperative pain, and length of hospital stay. Random‐effects network meta‐analysis was performed using odd ratios, mean differences, or standardized mean differences. Treatment effects were interpreted according to their magnitude and precision, with P‐scores used as a supplementary ranking measure. Results Fifty‐seven randomized controlled trials were included. Compared with conventional hemostasis, both advanced bipolar and ultrasonic devices were associated with lower rates of transient hypocalcemia (OR, 0.66 and 0.67, respectively) and postoperative pain. Ultrasonic devices significantly reduced intraoperative blood loss (SMD, −2.21), postoperative drain volume (MD, −18.6 mL), operative time (MD, −23.2 min), and length of hospital stay (MD, −0.36 days), whereas advanced bipolar devices also significantly reduced blood loss and operative time. Ultrasonic devices were highly ranked across several measures of operative efficiency; however, differences between contemporary advanced energy devices were generally modest and should be interpreted cautiously. Conclusions Advanced energy devices improve operative efficiency and are associated with favorable early postoperative outcomes with no clear evidence of increased major complications. However, rare major complications may limit definitive safety comparisons. Ultrasonic devices showed benefits across several operative outcomes, although treatment rankings should not be interpreted as definitive evidence of clinical superiority.