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Ab s t r Ac t Introduction: Blood loss, injury of recurrent laryngeal nerves, and damage of the parathyroid glands are the most dangerous complications during total thyroidectomy. The aim of our study is to compare the combined use of optical magnification and ultrasound hemostatic devices with traditional surgical suture ligation in terms of operating time, hospital stay, and surgical complications as bleeding, hypoparathyroidism, and recurrent laryngeal nerve injuries. Materials and methods: A total of 140 patients undergoing total thyroidectomy for either diffuse or nodular goiter were enrolled between January 2016 and June 2019 at our endocrine surgery unit. A total of 70 patients operated with magnifying loupes and ultrasonic scalpel, defined as group A, were compared with other 70 patients operated without loupes and with the aid of conventional hemostatic devices, named as group B. Results: Demographics were comparable between the assessed groups. Operating time was longer in group B (mean length of 110 minutes vs 79 minutes, p < 0.01). Intraoperative blood loss was lower in group A (22 mL vs 38 mL, p < 0.01). There were no differences between both groups in terms of postoperative bleeding, hematoma formation, pain control, and length of stay. Transient recurrent laryngeal nerve damage was observed in one case in group A and two cases in group B. Transient hypocalcemia secondary to hypoparathyroidism was more common in group B than in group A (31 patients vs 27 patients). Conclusion: In our study, use of magnification loupes and harmonic scalpel is associated with significant reduction of operating/anesthesia time and intraoperative blood loss. Clinical significance: Our results and suggestions can improve the standardized use of magnification loupes and harmonic scalpel in thyroid surgery.

Does the Combined Use of Magnification Loupes and Harmonic FOCUS Improve the Outcome of Thyroid Surgery?