Abstract
Background and Objectives: The most common complications after conventional thyroid surgery in adult patients are recurrent laryngeal nerve (RLN) injury and hypocalcemia. Magnification techniques (surgical loupes or surgical microscope) are used for identification of RLN and parathyroid glands to diminish these complications although more evidence is necessary to assess their safety and efficacy in comparison with direct vision. Methods and Materials: Electronic databases (Pubmed, Cochrane Library, Scopus) as well as gray literature sources were searched for randomized controlled trials (RCTs) comparing the frequency of transient/permanent RLN injury and hypocalcemia after thyroid surgery by using magnification techniques and direct vision for identification of RLN and parathyroid glands until October 17, 2019. The main outcomes were transient/permanent RLN injury and hypocalcemia. For all outcomes, 95% confidence intervals (95% CI) were used. Statistical analysis was performed with RevMan 5.3. Results: Systematic review and meta-analysis included 3 RCTs with 437 patients overall. Magnification techniques did not significantly affect the risk of occurrence of transient RLN injury (OR = 0.38, 95% CI (0.11–1.35), I2 = 0%) and transient hypocalcemia (OR = 0.31, 95% CI (0.09–1.09), I2 = 23%) compared with direct vision. Included RCTs demonstrated only two patients with permanent hypocalcemia and another one with permanent RLN injury, who belonged to the direct vision group. Conclusion: The use of magnification techniques for identification of RLN and parathyroid glands seems to be as safe as direct vision. However, they do not decrease the risk of RLN injury and transient hypocalcemia after thyroid surgery compared with direct vision. Finally, further prospective research should be conducted as the sample among the studies was small.
Highlights
Total thyroidectomy and unilateral thyroid lobectomy are common surgical procedures
The study concluded that the use of magnification techniques has no statistically significant effect on the risk of transient hypocalcemia and transient recurrent laryngeal nerve (RLN) injury compared with direct vision
The use of magnification techniques for the identification of parathyroid glands and RLN has no effect on the risk of temporary hypocalcemia and transient RLN injury after thyroid surgery
Summary
Total thyroidectomy and unilateral thyroid lobectomy are common surgical procedures. A microsurgical approach in thyroid surgery by using magnifying loupes or surgical microscope is believed to enhance the surgeon’s precision. The current systematic review and meta-analysis aimed to investigate if the use of magnification techniques in thyroid surgery is associated with the risk of RLN injury and hypocalcemia compared with direct vision. Such an association would have obvious clinical implications for safety and efficacy of magnification techniques in thyroid surgery
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