Discussion
In a retrospective study on 2 cohorts of patients of routine drainage vs no drainage following conventional SS, Coniglio et al [7] showed that the seroma rate was higher in the no drainage arm, 3.8% and 9.5% respectively, if tissue sealant is not administered to both arms. Although the difference is not statistically significant, it may well be due to inadequate power of sample size.
In a randomized controlled trial, Maharaj et al [8] demonstrated that adding tissue sealant for parotidectomy will reduce drain output which suggests that tissue sealant is a potential substance for the success of drainless parotidectomy. Duffin et al [9], in a retrospective study comparing tissue sealant alone vs tissue sealant plus drainage, there is less hematoma in former arm while the seroma rate is similar. The results indicate that drainage might not be necessary if tissue sealant is given.
Our series supports the concept of drainless parotidectomy if tissue sealant is administered. This is a homogenous series of consecutive patients who underwent minimally invasive parotidectomy (PP or ECD) with a standard of surgical technique for benign parotid nodules. However, the sample size is small. Nevertheless, there is no single incidence of seroma formation. We fully understand the small size of our series and therefore we shall continue to recruit more cases in order to illustrate a robust benefit of tissue sealant. Unfortunately, COVID-19 pandemic has suspended many elective operations, including parotidectomy.
Tissue sealant is not the single reason to achieve drainless parotidectomy when other parameters are factored in. From our experience, transformation of SS to PS / ECD, as well as retrograde facial nerve dissection will also contribute to the success by diminishing the dead space through less extensive surgery [3], [4]. Similarly, parotidectomy under local anesthesia will facilitate day surgery [5], [6].
To conclude, employment of tissue sealant in parotidectomy is safe and appears to obviate routine usage of drainage. This will enhance the practice of day surgery. We shall continue to recruit more cases to validate the benefit in a larger series.