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Comparison between Magnification Techniques and Direct Vision in Thyroid Surgery: A Systematic Review and
Konstantinos Sapalidis1, Anastasios Papanastasiou2, Varvara Fyntanidou3
1rd Department of Surgery, ``AHEPA`` University Hospital, Aristotle University of Thessaloniki, Medical School, 541 24 Thessaloniki, Greece. sapalidiskonstantinos@gmail.com.
Medicina (Kaunas, Lithuania)
|November 6, 2019
Summary
Using magnification techniques during thyroid surgery for recurrent laryngeal nerve (RLN) and parathyroid gland identification appears as safe as direct vision. However, magnification did not significantly reduce the risk of RLN injury or transient hypocalcemia.
Area of Science:
- Endocrinology
- Surgical Oncology
- Otolaryngology
Background:
- Recurrent laryngeal nerve (RLN) injury and hypocalcemia are common complications of conventional thyroid surgery.
- Magnification techniques (loupes, microscopes) aim to reduce these risks by improving identification of RLN and parathyroid glands.
- Evidence comparing magnification to direct vision for these complications is limited.
Purpose of the Study:
- To systematically review and meta-analyze randomized controlled trials (RCTs).
- To compare the safety and efficacy of magnification techniques versus direct vision in thyroid surgery.
- To assess the impact on transient/permanent RLN injury and hypocalcemia rates.
Main Methods:
- Searched electronic databases (PubMed, Cochrane, Scopus) and gray literature for RCTs.
- Included studies published up to October 17, 2019.
- Analyzed outcomes including transient/permanent RLN injury and hypocalcemia using RevMan 5.3 software.
Main Results:
- Included 3 RCTs with 437 patients.
- Magnification techniques showed no significant difference in transient RLN injury (OR=0.38) or transient hypocalcemia (OR=0.31) compared to direct vision.
- Permanent complications were rare, with only three cases (two hypocalcemia, one RLN injury) reported in the direct vision group.
Conclusions:
- Magnification techniques for RLN and parathyroid gland identification in thyroid surgery are as safe as direct vision.
- Current evidence does not support a reduced risk of RLN injury or transient hypocalcemia with magnification.
- Further prospective research with larger sample sizes is recommended.
