Comparative Study between Using Surgical Loupe and Direct Vision to Enhance Preservation of Parathyroid Glands and Minimize the Risk of its Injury during Total Thyroidectomy

Abstract

Background: Total thyroidectomy is now widely accepted as the gold standard for the management of thyroidcarcinoma and benign thyroid disease due to suspicion of malignancy, symptoms of local compression, and thepatient’s desire for rapid and definitive treatment. Damage of the parathyroid glands and injury of RLN are the mostdangerous complications during total thyroidectomy.Objective: Is to evaluate the impact of loupe magnification on incidental parathyroid gland removal andhypocalcemia after total thyroidectomy.Patients and Methods: In the present study, 60 patients who underwent total thyroidectomy, were classified intogroup A (Surgery with x 3 magnification= 30) or group B (surgery with direct vision= 30).Results: 12 patients (20%) had a toxic goiter and 48 patients (80%) had multinodular goiter. The mean age was43.93 ± 9.51 years in group A vs. 41.30 ± 10.29 years in group B, the mean operative time was 93.67 ± 5.34 minin group A vs. 97.07 ± 5.39 min in group B, The mean intraoperative bleeding was 164.76 ±16.08 ml in group Avs.176.04 ± 22.32 ml in group B. Only 8 cases of transient hypocalcemia which occured were resolved within 7days by oral calcium supplementation, the cases with transient hypocalcemia were 1(3.3%) in group A vs. 7 (35%)in group B.Conclusion: The use of loupe magnification for the identification of parathyroid glands and RLN reduced the rateof temporary hypocalcemia after thyroid surgery and significantly reduced the postoperative complications withoutincreasing the operating time.