Comment on garas et al., 'Which hemostatic device in thyroid surgery? A network meta-analysis of surgical technologies'

摘要

We disagree with the conclusions of the recent article by Garas et al. (1) on permanent recurrent laryngeal nerve injury (p-RLN) following thyroidectomy with different energy-based technologies using network meta-analysis. Since network meta-analysis extends the number and type of studies being combined, there is potential for combining studies that are not adequately similar, possibly leading to erroneous conclusions (2). One of the fundamental requirements of network meta-analysis to improve accuracy is that they include only very similar studies, under similar conditions, with similar patient populations, and clearly defined endpoints. Evaluation of the articles included by Garas et al. shows they have included a study using Star-ion (3), an electrocautery device, in the Harmonic arm and a nonrandomized trial in the Harmonic arm (4).