Title:
Letter to the editor: "A Prospective, Randomized, Controlled Comparative Study of Three Energy Devices in Open Thyroid Surgery: Thunder beat, Harmonic, and Ligasure.”
We read with interest "A prospective, randomized, controlled comparative study of three energy devices in open thyroid surgery; Thunder beat, harmonic and ligasure
" by backBack et al1al. This is a randomized study by a single surgeon which has added to the existing literature on hemostatic devices, analysing the role of each device and the strength, their strengths and weaknesses. The role of Thunder beat in reducing the time of CCLND with similar intraoperative and postoperative outcomes can be of much help in central dissectiondissections where the inferior parathyroid gland and the recurrent laryngeal nerve can be at risk 2. We also agree with the authors that individualizing the best device for that particular procedure can help in much-desired outcomes. We have a few queries which may interest future readers.
What was the cost difference incurred in using these instruments
, since in a developing country thismoney can be a determining factor might influenceinfluencing the usage of thesesuch devices? Did the surgeon tie the superior pole vessels and then use the hemostatic device? If an only a hemostatic device was used without any suture, then did the surgeon use a double seal or triple seal technique? For lymphatic vessel sealing, which hemostatic device do the authors prefer?

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