Use of optical magnification and microsurgical technique in general surgery

Orazi, V; Ortensi, A

doi:10.21767/amj.2017.3196

Cited by 4 publications

(3 citation statements)

References 35 publications

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“…Nevertheless, no association was shown in our series between the rate of perioperative complications and the complexity or duration of the operation. We strongly believe that total thyroidectomy performed by experienced surgeons with microsurgical technique under optical magnification permits to significantly reduce the incidence of permanent hypoparathyroidism and RLN lesions, as already demonstrated in our previous studies and confirmed by numerous evidences in the literature [35][36][37][38][39][40].…”

Section: Discussionsupporting

confidence: 83%

May predictors of difficulty in thyroid surgery increase the incidence of complications? Prospective study with the proposal of a preoperative score

D’Orazi

Sacconi²,

Trombetta³

et al. 2019

BMC Surg

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Background: Although thyroidectomy is one of the most common surgical procedures performed worldwide, some permanent complications, despite the considerably reducing incidence, may affect dramatically the patients quality of life. The purpose of this study is to evaluate whether factors identified preoperatively and expressed in a score could be predictors of major surgical difficulty during total thyroidectomy and influence the incidence of complications. Methods: A total of 164 patients who underwent total thyroidectomy were examined. For each patient we calculated a preoperative score, including seven parameters, which we evaluated to be predictors of difficulty in thyroid surgery, that is, sex, body mass index (BMI), neck length, neck extension, thyroid gland volume, thyroiditis, and increased parenchymal vascularization. The overall score was also compared with peri-and post-operative factors describing objectively the difficulty in thyroid surgery. These factors are the duration of the operation, the length of hospitalization, the incidence of complications such as hemorrhage, hypoparathyroidism, and recurrent laryngeal nerve injuries. Results: There was no statistically significant association between our score and either the percentage of postoperative complications or the length of hospitalization. The operative time was the only variable remarkably associated with the score value (p < 0.00001). Comparing the duration of the operation with each of the preoperative predictive factors, we found that none of the factors reached the value of statistical significance, but a close association could be noted with the thyroid volume and the BMI. Conclusions: In our study, predictors of difficulty in thyroidectomy did not affect morbidity rates, as suggested by previous studies, but only operative times, which were significantly increased in patients with higher score. Although our results have limited statistical significance, they allow us to confirm the fundamental role of a systematic use of optical magnification and microsurgical technique in thyroidectomy. Further studies, with a larger cohort of patients, are needed to validate our results and to formulate a universally accepted predictive score of difficulty in thyroidectomy preoperatively.

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Section: Discussionsupporting

confidence: 83%

May predictors of difficulty in thyroid surgery increase the incidence of complications? Prospective study with the proposal of a preoperative score

D’Orazi

Sacconi²,

Trombetta³

et al. 2019

BMC Surg

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“…Therefore, using magnifying loupes in thyroid surgery is advocated to increase the surgeon’s precision. Additionally, the above anatomical structures could be easily identified during surgery 6 . The first surgical application of the loupe procedure in thyroid surgery was reported by Atti and Khafif in 1975 7 .…”

Section: Introductionmentioning

confidence: 99%

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

Nagaty¹,

Shehata²,

Elkady³

et al. 2023

Annals of Medicine &Amp; Surgery

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Objective: 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.

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“…Therefore, a microsurgical approach in thyroid surgery by using magnifying loupes or surgical microscope is believed to enhance the surgeon’s precision. Also, it was stated that the above anatomical structures could be identified in an easier way during the operation [3]. The first microsurgical thyroidectomy was reported in 1975 by Atti et al [4].…”

Section: Introductionmentioning

confidence: 99%

Comparison between Magnification Techniques and Direct Vision in Thyroid Surgery: A Systematic Review and Meta-Analysis

et al. 2019

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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.

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Use of optical magnification and microsurgical technique in general surgery

Abstract: EDITORIALPlease cite this paper as: D'Orazi V, Ortensi A. Use of optical magnification and microsurgical technique in general surgery.

Cited by 4 publications

References 35 publications

May predictors of difficulty in thyroid surgery increase the incidence of complications? Prospective study with the proposal of a preoperative score

May predictors of difficulty in thyroid surgery increase the incidence of complications? Prospective study with the proposal of a preoperative score

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

Comparison between Magnification Techniques and Direct Vision in Thyroid Surgery: A Systematic Review and Meta-Analysis

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