{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T05:01:12Z","timestamp":1790398872081,"version":"4.1.0"},"reference-count":26,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2019,11,1]],"date-time":"2019-11-01T00:00:00Z","timestamp":1572566400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: The most common complications after conventional thyroid surgery in adult patients are recurrent laryngeal nerve (RLN) injury and hypocalcemia. Magnification techniques (surgical loupes or surgical microscope) are used for identification of RLN and parathyroid glands to diminish these complications although more evidence is necessary to assess their safety and efficacy in comparison with direct vision. Methods and Materials: Electronic databases (Pubmed, Cochrane Library, Scopus) as well as gray literature sources were searched for randomized controlled trials (RCTs) comparing the frequency of transient\/permanent RLN injury and hypocalcemia after thyroid surgery by using magnification techniques and direct vision for identification of RLN and parathyroid glands until October 17, 2019. The main outcomes were transient\/permanent RLN injury and hypocalcemia. For all outcomes, 95% confidence intervals (95% CI) were used. Statistical analysis was performed with RevMan 5.3. Results: Systematic review and meta-analysis included 3 RCTs with 437 patients overall. Magnification techniques did not significantly affect the risk of occurrence of transient RLN injury (OR = 0.38, 95% CI (0.11\u20131.35), I2 = 0%) and transient hypocalcemia (OR = 0.31, 95% CI (0.09\u20131.09), I2 = 23%) compared with direct vision. Included RCTs demonstrated only two patients with permanent hypocalcemia and another one with permanent RLN injury, who belonged to the direct vision group. Conclusion: The use of magnification techniques for identification of RLN and parathyroid glands seems to be as safe as direct vision. However, they do not decrease the risk of RLN injury and transient hypocalcemia after thyroid surgery compared with direct vision. Finally, further prospective research should be conducted as the sample among the studies was small.<\/jats:p>","DOI":"10.3390\/medicina55110725","type":"journal-article","created":{"date-parts":[[2019,11,1]],"date-time":"2019-11-01T12:30:50Z","timestamp":1572611450000},"page":"725","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Comparison between Magnification Techniques and Direct Vision in Thyroid Surgery: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"55","author":[{"given":"Konstantinos","family":"Sapalidis","sequence":"first","affiliation":[{"name":"3rd Department of Surgery, \u201cAHEPA\u201d University Hospital, Aristotle University of Thessaloniki, Medical School, 541 24 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3508-1299","authenticated-orcid":false,"given":"Anastasios","family":"Papanastasiou","sequence":"additional","affiliation":[{"name":"3rd Department of Surgery, \u201cAHEPA\u201d University Hospital, Aristotle University of Thessaloniki, Medical School, 541 24 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Varvara","family":"Fyntanidou","sequence":"additional","affiliation":[{"name":"3rd Department of Surgery, \u201cAHEPA\u201d University Hospital, Aristotle University of Thessaloniki, Medical School, 541 24 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zoi","family":"Aidoni","sequence":"additional","affiliation":[{"name":"3rd Department of Surgery, \u201cAHEPA\u201d University Hospital, Aristotle University of Thessaloniki, Medical School, 541 24 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaos","family":"Michalopoulos","sequence":"additional","affiliation":[{"name":"3rd Department of Surgery, \u201cAHEPA\u201d University Hospital, Aristotle University of Thessaloniki, Medical School, 541 24 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Athanasios","family":"Katsaounis","sequence":"additional","affiliation":[{"name":"3rd Department of Surgery, \u201cAHEPA\u201d University Hospital, Aristotle University of Thessaloniki, Medical School, 541 24 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aikaterini","family":"Amaniti","sequence":"additional","affiliation":[{"name":"Anesthisiology Department, \u201cAHEPA\u201d University Hospital, Aristotle University of Thessaloniki, Medical School, 541 24 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5119-2207","authenticated-orcid":false,"given":"Paul","family":"Zarogoulidis","sequence":"additional","affiliation":[{"name":"3rd Department of Surgery, \u201cAHEPA\u201d University Hospital, Aristotle University of Thessaloniki, Medical School, 541 24 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charilaos","family":"Koulouris","sequence":"additional","affiliation":[{"name":"3rd Department of Surgery, \u201cAHEPA\u201d University Hospital, Aristotle University of Thessaloniki, Medical School, 541 24 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8438-4050","authenticated-orcid":false,"given":"Dimitrios","family":"Giannakidis","sequence":"additional","affiliation":[{"name":"3rd Department of Surgery, \u201cAHEPA\u201d University Hospital, Aristotle University of Thessaloniki, Medical School, 541 24 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aris","family":"Ioannidis","sequence":"additional","affiliation":[{"name":"3rd Department of Surgery, \u201cAHEPA\u201d University Hospital, Aristotle University of Thessaloniki, Medical School, 541 24 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iason-Nikolaos","family":"Katsios","sequence":"additional","affiliation":[{"name":"3rd Department of Surgery, \u201cAHEPA\u201d University Hospital, Aristotle University of Thessaloniki, Medical School, 541 24 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Romanidis","sequence":"additional","affiliation":[{"name":"Second Department of Surgery, University Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Panagoula","family":"Oikonomou","sequence":"additional","affiliation":[{"name":"Second Department of Surgery, University Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isaak","family":"Kesisoglou","sequence":"additional","affiliation":[{"name":"3rd Department of Surgery, \u201cAHEPA\u201d University Hospital, Aristotle University of Thessaloniki, Medical School, 541 24 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoforos","family":"Kosmidis","sequence":"additional","affiliation":[{"name":"3rd Department of Surgery, \u201cAHEPA\u201d University Hospital, Aristotle University of Thessaloniki, Medical School, 541 24 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,11,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3844","DOI":"10.1245\/s10434-014-3846-8","article-title":"Total thyroidectomy is associated with increased risk of complications for low- and high-volume surgeons","volume":"21","author":"Hauch","year":"2014","journal-title":"Ann Surg Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"830","DOI":"10.1089\/thy.2017.0309","article-title":"American Thyroid Association Statement on Postoperative Hypoparathyroidism: Diagnosis, Prevention, and Management in Adults","volume":"28","author":"Orloff","year":"2018","journal-title":"Thyroid"},{"key":"ref_3","first-page":"989","article-title":"Use of optical magnification and microsurgical technique in general surgery","volume":"10","author":"Ortensi","year":"2017","journal-title":"Australas Med. J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1016\/0002-9610(75)90472-9","article-title":"Preservation of parathyroid glands during total thyroidectomy. Improved technic utilizing microsurgery","volume":"130","author":"Attie","year":"1975","journal-title":"Am. J. Surg."},{"key":"ref_5","first-page":"101","article-title":"Use of loupes magnification and microsurgical technique in thyroid surgery: Ten years experience in a single center","volume":"37","author":"Panunzi","year":"2016","journal-title":"G Chir."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1017\/S0022215100141076","article-title":"Microsurgical technique in thyroid surgery-A 10-year experience","volume":"112","author":"Nielsen","year":"1998","journal-title":"J. Laryngol. Otol."},{"key":"ref_7","first-page":"5","article-title":"Microsurgical technique as a method for prevention of recurrent laryngeal nerve injury in thyroid surgery. Review of seven consecutive cases","volume":"43","author":"Doikov","year":"2001","journal-title":"Folia Med (Plovdiv)."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1002\/(SICI)1098-2752(1998)18:8<460::AID-MICR6>3.0.CO;2-H","article-title":"Usefulness of microsurgery to isolation of recurrent laryngeal nerve and parathyroid during thyroidectomy operations","volume":"18","author":"Cavallaro","year":"1998","journal-title":"Microsurgery"},{"key":"ref_9","first-page":"46","article-title":"Approach to the recurrent laryngeal nerve in thyroid surgery","volume":"11","author":"Erkam","year":"2003","journal-title":"Kulak Burun Bogaz Ihtis Derg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1111\/coa.12284","article-title":"Microscope-assisted thyroidectomy: Our experience in one hundred and twenty-one consecutive cases","volume":"39","author":"Williams","year":"2014","journal-title":"Clin. Otolaryngol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1007\/s00405-004-0740-1","article-title":"Microscopic thyroidectomy: A prospective controlled trial","volume":"262","author":"Seven","year":"2005","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_12","first-page":"29","article-title":"A revised tool for assessing risk of bias in randomized trials","volume":"10","author":"Higgins","year":"2016","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1002\/micr.10195","article-title":"Total thyroidectomy is improved by loupe magnification","volume":"24","author":"Testini","year":"2004","journal-title":"Microsurgery"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1007\/s10353-011-0591-0","article-title":"Total thyroidectomy by loupe magnification: A comparative study","volume":"43","author":"Saber","year":"2011","journal-title":"Eur. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1345","DOI":"10.1177\/000313481007601218","article-title":"Loupe magnification reduces postoperative hypocalcemia after total thyroidectomy","volume":"76","author":"Pata","year":"2010","journal-title":"Am. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1002\/hed.21157","article-title":"Adopting the operating microscope in thyroid surgery: Safety, efficiency, and ergonomics","volume":"32","author":"Davidson","year":"2010","journal-title":"Head Neck."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1089\/thy.2014.0101","article-title":"Effectiveness of preventative and other surgical measures on hypocalcemia following bilateral thyroid surgery: A systematic review and meta-analysis","volume":"25","author":"Antakia","year":"2015","journal-title":"Thyroid"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1067\/msy.2001.118264","article-title":"Comparison between minimally invasive video-assisted thyroidectomy and conventional thyroidectomy: A prospective randomized study","volume":"130","author":"Miccoli","year":"2001","journal-title":"Surgery"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1002\/hed.20118","article-title":"Safety of video-assisted thyroidectomy versus conventional surgery","volume":"27","author":"Lombardi","year":"2005","journal-title":"Head Neck"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"97","DOI":"10.4103\/0972-9941.59307","article-title":"Minimally invasive video-assisted thyroidectomy versus conventional thyroidectomy: A single-blinded, randomized controlled clinical trial","volume":"5","year":"2009","journal-title":"J. Minim. Access. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1007\/s00423-013-1125-y","article-title":"Systematic review with meta-analysis of prospective randomized trials comparing minimally invasive video-assisted thyroidectomy (MIVAT) and conventional thyroidectomy (CT)","volume":"398","author":"Pisanu","year":"2013","journal-title":"Langenbeck\u2019s Arch. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1016\/j.ejso.2016.09.017","article-title":"Total thyroidectomy alone versus ipsilateral versus bilateral prophylactic central neck dissection in clinically node-negative differentiated thyroid carcinoma. A retrospective multicenter study","volume":"43","author":"Calo","year":"2017","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1186\/s12957-016-0879-4","article-title":"Role of prophylactic central compartment lymph node dissection in clinically N0 differentiated thyroid cancer patients: Analysis of risk factors and review of modern trends","volume":"14","author":"Conzo","year":"2016","journal-title":"World J. Surg. Oncol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1358","DOI":"10.1007\/s00268-008-9483-2","article-title":"Intraoperative monitoring of the recurrent laryngeal nerve in thyroid surgery","volume":"32","author":"Dralle","year":"2008","journal-title":"World J. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1097\/SLA.0b013e318294559d","article-title":"Limits of neuromonitoring in thyroid surgery","volume":"258","author":"Dionigi","year":"2013","journal-title":"Ann. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1007\/s00104-012-2272-3","article-title":"Thyroid gland surgery: Risk factor surgeon","volume":"83","author":"Dralle","year":"2012","journal-title":"Chirurg"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/55\/11\/725\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T13:31:16Z","timestamp":1760189476000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/55\/11\/725"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,11,1]]},"references-count":26,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2019,11]]}},"alternative-id":["medicina55110725"],"URL":"https:\/\/doi.org\/10.3390\/medicina55110725","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,11,1]]}}}