Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India · 2022
Minimally Invasive Parathyroidectomy as the Surgical Management of Single Parathyroid Adenomas: A Tertiary Care Experience.
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Agalar Afra, Laible Deborah, Im Jihee, Van Norden Clare, Cruz Alysia, Carlo Gustavo, Ispa Jean
Аннотация
OBJECTIVE: To synthesize evidence from randomized controlled trials (RCTs) comparing virtual surgical planning (VSP) with conventional surgical planning (CSP) in orthognathic surgery, focusing on surgical accuracy, soft-tissue prediction, operative efficiency, costs, and patient-reported outcomes.
METHODS: While adhering to PRISMA 2020 recommendations, this systematic review and meta-analysis was prospectively registered in PROSPERO (CRD420261279888). RCTs involving adults undergoing orthognathic surgery were identified through electronic searches of PubMed, Cochrane Library, and ScienceDirect (2000-2025). Primary outcomes included hard-tissue surgical accuracy (linear mm/angular ° deviation) and soft-tissue prediction accuracy. Secondary outcomes were planning time, surgical duration, costs, radiation exposure, and patient-reported outcomes. Random-effects meta-analyses used mean difference (MD) or standardized mean difference (SMD). Certainty of evidence was assessed with GRADE.
RESULTS: Eleven RCTs (240 patients) were included. VSP significantly reduced surgical duration compared to CSP (SMD - 2.53, 95% CI - 4.45 to - 0.60, p = 0.01, I²=68%, low certainty). Patient-reported outcomes showed no difference between groups (SMD 0.05, 95% CI - 0.30 to 0.40, p = 0.70, I²=0%, low certainty). No significant difference was found for maxillary horizontal accuracy (MD - 0.41 mm, 95% CI - 1.01 to 0.18, p = 0.17, I²=92%, very low certainty). For maxillary vertical accuracy, VSP showed a statistically significant but clinically modest improvement (MD - 0.46 mm, 95% CI - 0.92 to - 0.01, p = 0.04, I²=81%, very low certainty). Subgroup analysis revealed greater vertical accuracy benefits with guide/plate-based transfer (MD - 0.89 mm) versus splint-based transfer (MD - 0.24 mm), with significant subgroup differences (p = 0.001). VSP was associated with higher costs and radiation exposure.
CONCLUSIONS: VSP offers statistically significant improvements in vertical accuracy and surgical duration, but benefits are modest, clinically questionable, and largely driven by advanced transfer techniques. Very low certainty evidence and increased costs limit routine recommendation. VSP may be best reserved for complex cases where precision is paramount.
SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at https://doi.org/10.1007/s12663-026-03236-w.
METHODS: While adhering to PRISMA 2020 recommendations, this systematic review and meta-analysis was prospectively registered in PROSPERO (CRD420261279888). RCTs involving adults undergoing orthognathic surgery were identified through electronic searches of PubMed, Cochrane Library, and ScienceDirect (2000-2025). Primary outcomes included hard-tissue surgical accuracy (linear mm/angular ° deviation) and soft-tissue prediction accuracy. Secondary outcomes were planning time, surgical duration, costs, radiation exposure, and patient-reported outcomes. Random-effects meta-analyses used mean difference (MD) or standardized mean difference (SMD). Certainty of evidence was assessed with GRADE.
RESULTS: Eleven RCTs (240 patients) were included. VSP significantly reduced surgical duration compared to CSP (SMD - 2.53, 95% CI - 4.45 to - 0.60, p = 0.01, I²=68%, low certainty). Patient-reported outcomes showed no difference between groups (SMD 0.05, 95% CI - 0.30 to 0.40, p = 0.70, I²=0%, low certainty). No significant difference was found for maxillary horizontal accuracy (MD - 0.41 mm, 95% CI - 1.01 to 0.18, p = 0.17, I²=92%, very low certainty). For maxillary vertical accuracy, VSP showed a statistically significant but clinically modest improvement (MD - 0.46 mm, 95% CI - 0.92 to - 0.01, p = 0.04, I²=81%, very low certainty). Subgroup analysis revealed greater vertical accuracy benefits with guide/plate-based transfer (MD - 0.89 mm) versus splint-based transfer (MD - 0.24 mm), with significant subgroup differences (p = 0.001). VSP was associated with higher costs and radiation exposure.
CONCLUSIONS: VSP offers statistically significant improvements in vertical accuracy and surgical duration, but benefits are modest, clinically questionable, and largely driven by advanced transfer techniques. Very low certainty evidence and increased costs limit routine recommendation. VSP may be best reserved for complex cases where precision is paramount.
SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at https://doi.org/10.1007/s12663-026-03236-w.