Efficacy and safety of high-frequency electrosurgery, ultrasonic scalpel, and bipolar electrocoagulation in parathyroidectomy for secondary hyperparathyroidism: a 3-year follow-up retrospective study

This study aimed to evaluate the surgical outcomes of parathyroidectomy (PTX) for secondary hyperparathyroidism (SHPT) in hemodialysis patients, comparing the use of three operative techniques: high-frequency electrosurgery (HFE), ultrasonic scalpel (US), and bipolar electrocoagulation (BPE). The patients were divided into three groups based on the type of surgical instruments used. Outcomes assessed included surgical efficiency, postoperative complications, recurrence rate, hospitalization costs, biochemical and nutritional parameters over 1 year, and overall survival through March 2025. A total of 171 patients were retrospectively categorized into three groups: HFE (n = 50), US (n = 60), and BPE (n = 61). Compared to group HFE, both the US and BPE groups exhibited significantly shorter durations for drainage tube removal, operative times, and postoperative hospital stays (all p < 0.05). The BPE group also had significantly lower intraoperative blood loss compared to the US and HFE groups (p < 0.05) and incurred the lowest hospitalization costs. The incidence of postoperative complications and recurrence rates did not differ significantly among groups. All groups showed marked reductions in serum calcium, phosphorus, and intact parathyroid hormone levels postoperatively, which stabilized over time with no significant differences between groups. At the 1-year follow-up, patients exhibited significant improvements in anemia-related and nutritional markers compared to baseline. With follow-up extending to March 2025, overall survival did not differ significantly among the three surgical groups (p = 0.987). PTX effectively corrected SHPT, improved anemia, and enhanced nutritional status in hemodialysis patients. All three surgical techniques, HFE, US, and BPE, were safe and effective, with comparable long-term survival. However, US and BPE offered superior operative efficiency, and BPE represented the most cost-effective option.