Can the operating time be reduced by use of magnification in Total Thyroidectomy? A preliminary Study

Introduction: Total thyroidectomy is a major surgical procedure which is becoming increasingly popular. Operating Time taken for total thyroidectomy can be approximately 3- 4 hours. Thyroidectomy surgeries still occupy a significant portion of busy general surgical lists in high volume thyroid centers such as Surgical Professorial Unit of Teaching Hospital Karapitiya. With resource constrains this implies much theatre time, staff and costs with significant bearing on health care demands. Reduction in operating time with consequent reduction in time under anesthesia is beneficial to patient too. This study was carried out to explore whether the surgical time is reduced by using magnification by the surgeon for total thyroidectomy.

Methods: The operating procedure of total thyroidectomy was divided in to 10 phases for the purpose of study. Surgeon A, who has been doing thyroid surgery for last 10 years without any magnification, was selected as the object of the study. Three total thyroidectomies performed by surgeon A was observed and records were made by surgeon B for timing of each phase and for any other significant events occurred during the operation. Surgeon A has been using magnification for next 10 thyroidectomies which allowed him to get over the steepest part of the learning curve. This was not included in the study. Subsequently surgeon A performed 14 thyroidectomies over next two months and 11 of them were observed by the other surgeon B.

Results: Results of the three observed thyroidectomies done without magnification: Control Group (CG) was compared with the group in which thyroidectomies were done under magnification: Study Group (SG). There were no significant difference between SG and CG with regard to time taken during the path from skin incision to isthmus (S1). During the dissection over anterolateral surface of the left lobe (S2) significant difference was observed with CG gaining 1.91 minute average time advantage. More deliberations were observed over small strands containing minute blood vessels which were usually dissected bluntly in CG. Total operating time (Skin to skin) was 109.76 minutes for SG and 146.67 for CG.

Conclusion: The study shows that approximately 45 minute reduction in operating time can be achieved with use of loupes. This preliminary study has given an insight in to how and why operating time for total thyroidectomy can be reduced by the use of loupe magnification.