Implication of surgical loupes on complications following thyroidectomy: a meta-analysis

Objective: To determine the effectiveness of surgical loupes in reducing postoperative RLN palsy and hypocalcemia following thyroidectomy. Data sources: PubMed, Scopus and Google Scholar databases were searched between 2000 and 2024. Review methods: Studies were included if they reported at least one complication outcome following thyroidectomy using surgical loupes. The outcome measure was the log odds ratio, with negative log odds indicating results favouring the experimental group. The model utilized the DerSimonian-Laird estimator, and Wald-type tests. Results: The qualitative data synthesis included 813 patients from 6 included studies, including 410 patients with surgical loupes and 403 patients without surgical loupes. There was a statistically significant reduction in the rate of temporary RLN palsy in the surgical loupe group log(OR) = − 0.87 [(− 1.58, − 0.15), DL (Dersimonian and Laird method), REM (random effects model), CI (confidence interval) = 95%], or a 41.8% lower probability. The rates of permanent RLN palsy log(OR) = − 0.31 [(− 1.45, 0.82), DL, REM, CI = 95%], temporary hypocalcemia log(OR) = − 0.34 [(− 1.25, 0.57), DL, REM, CI = 95%], and permanent hypocalcemia log(OR) = − 0.85 [(− 2.24, 0.54), DL, REM, CI = 95%] were not statistically significant between the two groups, although there were trends toward decreases in these rates in the loupes group. Conclusions: Surgical loupe use during thyroidectomy can lead to a 41.8% lower probability of temporary RLN palsy compared to operating without loupes. Level of evidence: 3a.