An assessment of the role of surgical loupe technique in prevention of postthyroidectomy complications: a comparative prospective study

Abstract

The magnification technique offered by surgical loupe is a new method that enhances visualization and helps head and neck surgeons with recurrent laryngeal nerve (RLN) and parathyroid glands identification. This study aimed to assess the safety and efficacy of using binocular surgical loupes in thyroidectomy procedures.

Material and methods: Eighty patients with thyroid nodules who underwent thyroidectomy procedure were divided randomly into two comparable groups, group A subjected to thyroidectomy by using binocular magnification loupe, group B underwent conventional thyroidectomy without using magnification. Patients' demographics, operation time, and postoperative morbidities were recorded. All cases had preoperative and postoperative vocal cords assessment by video laryngoscopy. Pathology, laboratory, and radiology investigations were also conducted.

Results: Out of 80 patients, there were 58 females and 22 males. Benign thyroid pathology was found in 74 patients and malignant pathology in 6 patients. The mean operating time was 106 min in group A compared to 138.5 min in group B. The mean amount of intraoperative bleeding was 30 ml in group A while 50 ml in group B. There were no cases of the external branch of the superior laryngeal nerve in both groups; there was better identification in group A. There was only one patient who suffered from a temporary RLN injury in group A, while three cases of temporary and one case of permanent RLN injury were recorded in group B. Permanent hypoparathyroidism was diagnosed in only one patient in group B.

Conclusion: The utilization of binocular surgical loupe magnification in thyroid surgery is considered a safe and effective maneuver that has the advantages of decreasing the overall operating time and significantly reducing postoperative complications.

Keywords: hypocalcemia; recurrent laryngeal nerve; thyroid neoplasms; thyroidectomy.

Figure 1

The surgical loupe.

Figure 2

Recurrent laryngeal nerve exposure during a surgical operation.

Figure 3

A picture of shown inferior parathyroid gland (arrow).

Figure 4

A picture of shown external branch of the superior laryngeal nerve (arrow).

Figure 5

Ultrasonography picture of right thyroid lobe middle zone cystic nodule with contour bulge.

Figure 6

Histopathology picture of two different cases: (A) a nodular goiter lesion showing variable sized acini lined by cubical follicular cells and filled by colloid with occasional macrophages. (B) A case of papillary thyroid carcinoma, encapsulated follicular variant showing nuclear enlargement and clearing with scanty colloid (hematoxylin and eosin stain).