Comparative Effectiveness and Safety of Energy Devices for Thyroidectomy: An Outcome-Specific Network Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: We performed an outcome-specific network meta-analysis comparing contemporary energy devices in thyroidectomy. METHODS: Randomized controlled trials comparing conventional hemostasis with Harmonic, LigaSure, Thunderbeat, or other advanced energy devices during thyroidectomy were included. Frequentist random-effects network meta-analyses were performed per outcome, with treatments ranked by P-scores and consistency assessed via design-by-treatment interaction and node-splitting analyses. RESULTS: Compared to conventional hemostasis, Harmonic significantly reduced operative time (SMD, -1.88), blood loss (SMD, -2.29), drainage volume (SMD, -1.77), hospital stay (SMD, -0.74), transient hypocalcemia (OR, 0.61), transient recurrent laryngeal nerve palsy (OR, 0.63), and postoperative bleeding (OR, 0.56). LigaSure improved operative efficiency but showed less consistent recovery and safety benefits. Harmonic ranked highest across most outcomes. CONCLUSIONS: Harmonic showed the most favorable relative effects across the evaluated outcomes. However, these findings do not establish overall device superiority; selection should consider absolute benefits and device-specific characteristics.