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

Background: Total thyroidectomy is now widely accepted as the gold standard for the management of thyroid
carcinoma and benign thyroid disease due to suspicion of malignancy, symptoms of local compression, and the
patient’s desire for rapid and definitive treatment. Damage of the parathyroid glands and injury of RLN are the most
dangerous complications during total thyroidectomy.
Objective: Is to evaluate the impact of loupe magnification on incidental parathyroid gland removal and
hypocalcemia after total thyroidectomy.
Patients and Methods: In the present study, 60 patients who underwent total thyroidectomy, were classified into
group 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 was
43.93 ± 9.51 years in group A vs. 41.30 ± 10.29 years in group B, the mean operative time was 93.67 ± 5.34 min
in group A vs. 97.07 ± 5.39 min in group B, The mean intraoperative bleeding was 164.76 ±16.08 ml in group A
vs.176.04 ± 22.32 ml in group B. Only 8 cases of transient hypocalcemia which occured were resolved within 7
days 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 rate
of temporary hypocalcemia after thyroid surgery and significantly reduced the postoperative complications without
increasing the operating time.