Frontiers in endocrinology · 2026
Experience over tools: does the use of magnifying loupes reduce the incidence of transient postoperative hypocalcemia after total thyroidectomy with central neck dissection? - a single-centre prospective randomized study.
СтатьяРандомизированное исследованиеНазвание и аннотация: Перевод в очереди
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Sielski Wojciech, Osęka Tomasz, Antolak Artur, Kaska Łukasz, Żawrocki Anton, Kucewicz Michał T, Dymecki Dariusz
Аннотация
BACKGROUND: Parathyroid preservation during total thyroidectomy with central neck dissection in papillary thyroid carcinoma remains challenging due to the glands' delicate vascular anatomy and risk of inadvertent devascularization or excision. Although advanced technologies exist, lowcost 2.5× magnifying loupes have been proposed as a simple alternative. High-level evidence of their benefit in experienced hands is limited.
METHODS: This single-centre prospective randomized controlled trial enrolled 108 patients with low-risk papillary thyroid carcinoma (T1-T2, single tumour ≤2 cm) undergoing total thyroidectomy plus prophylactic level VI central neck dissection. Patients were randomized 1:1 to the magnifying loupes group (ML T+6L, n=54) or naked-eye control group (T+6L, n=54). All procedures were performed by the same experienced surgeon using a standardized capsular dissection technique. The primary endpoint was the incidence of transient postoperative hypocalcemia (serum calcium <8.0 mg/dL on postoperative day 2 and/or need for calcium supplementation).
RESULTS: Transient hypocalcemia occurred in 31.5% of patients in the loupes group versus 33.3% in the control group (p=1.000). There were no significant differences in clinical symptoms of hypocalcemia, need for intravenous calcium, change in serum calcium (ΔCa), change in PTH (ΔPTH), number of identified parathyroid glands, or rate of incidental parathyroid excision. Operative time was significantly longer with loupes (144.1 ± 31.7 vs 125.4 ± 29.8 min; p=0.001). No cases of permanent hypoparathyroidism occurred in either group during 6-month follow-up.
CONCLUSION: In the hands of an experienced surgeon, the routine use of 2.5× magnifying loupes did not reduce the incidence of transient postoperative hypocalcemia after total thyroidectomy with central neck dissection. However, their use was associated with longer operative time and subjectively improved precision, suggesting potential value as a training tool for promoting meticulous dissection technique in less experienced surgeons.
METHODS: This single-centre prospective randomized controlled trial enrolled 108 patients with low-risk papillary thyroid carcinoma (T1-T2, single tumour ≤2 cm) undergoing total thyroidectomy plus prophylactic level VI central neck dissection. Patients were randomized 1:1 to the magnifying loupes group (ML T+6L, n=54) or naked-eye control group (T+6L, n=54). All procedures were performed by the same experienced surgeon using a standardized capsular dissection technique. The primary endpoint was the incidence of transient postoperative hypocalcemia (serum calcium <8.0 mg/dL on postoperative day 2 and/or need for calcium supplementation).
RESULTS: Transient hypocalcemia occurred in 31.5% of patients in the loupes group versus 33.3% in the control group (p=1.000). There were no significant differences in clinical symptoms of hypocalcemia, need for intravenous calcium, change in serum calcium (ΔCa), change in PTH (ΔPTH), number of identified parathyroid glands, or rate of incidental parathyroid excision. Operative time was significantly longer with loupes (144.1 ± 31.7 vs 125.4 ± 29.8 min; p=0.001). No cases of permanent hypoparathyroidism occurred in either group during 6-month follow-up.
CONCLUSION: In the hands of an experienced surgeon, the routine use of 2.5× magnifying loupes did not reduce the incidence of transient postoperative hypocalcemia after total thyroidectomy with central neck dissection. However, their use was associated with longer operative time and subjectively improved precision, suggesting potential value as a training tool for promoting meticulous dissection technique in less experienced surgeons.