Comparative Use of Double Bipolar Forceps Versus Ultrasound Energy Device in Transoral Robotic Thyroidectomy.

Abstract

Transoral robotic thyroidectomy (TORT) offers excellent cosmetic outcomes and safe access to the central neck without a cervical incision. Traditionally, ultrasonic energy devices have been used for dissection and hemostasis, though these instruments are limited by unilateral use, bulkiness, and greater thermal spread. Double bipolar forceps, when used bilaterally, provide enhanced precision, full articulation, smoke reduction, and integration with intraoperative nerve monitoring, thereby enabling efficient bimanual dissection and continuous traction without frequent instrument exchanges. This video illustrates the operative techniques of both ultrasonic energy devices and double bipolar forceps in TORT, highlighting their technical nuances and practical advantages. In a retrospective study of 1726 TORT cases performed by a single surgeon, operative times were significantly shorter in the double bipolar forceps group compared with the ultrasonic device group (lobectomy: 131.7 ± 25.1 min vs. 174.7 ± 35.2 min, p < 0.001; total thyroidectomy: 185.6 ± 44.7 min vs. 217.4 ± 65.8 min, p < 0.001), while complication rates were comparable. Together, the video and clinical data underscore the value of bipolar forceps as an effective alternative to conventional energy devices in robotic thyroid surgery.