Comparing surgical loupes and operating microscopes: a systematic review of efficacy, safety, and added value
Year: 2025
Type: review
Study design: Systematic Review
Abstract: INTRODUCTION: Operating microscopes and surgical loupes are essential tools in modern surgery, particularly in microsurgical procedures requiring high precision. While both offer magnification and enhanced visualization, it remains uncertain whether one is superior in terms of effectiveness, safety, and cost.EVIDENCE ACQUISITION: A systematic search of Medline, Embase, Web of Science, and Cochrane Library was conducted for studies published between 1921 and 2023 comparing loupe-assisted and microscope-assisted microsurgical procedures. Excluded were non-English articles, conference abstracts, errata, and unpublished data. The risk of bias was assessed using the ROBINS-I and AMSTAR 2 tools. Key outcomes included adverse events, success rates, operating time, hospital stay, cost, and surgeon preferences. Results were summarized without meta-analysis and visualized using forest plots.EVIDENCE SYNTHESIS: Out of 1311 studies, 41 were included. Microscope-assisted surgeries showed longer operating times but shorter hospital stays and lower post-operative complication rates, especially in procedures involving small anatomical structures. Loupes provided comparable outcomes for surgeries involving larger structures and were significantly less expensive. No strong overall surgeon preference was observed. The quality of studies ranged from low to moderate, limiting the generalizability of findings and the strength of the conclusions.CONCLUSIONS: Microscopes offer superior precision, ergonomics, and outcomes for surgeries requiring high magnification, but loupes are a cost-effective alternative, particularly for low-risk or resource-constrained settings. The choice of tool should consider clinical context, structure size, complication risks, and resource availability. High-quality randomized trials are necessary to better delineate the comparative benefits and optimize surgical outcomes.
Source: Minerva Orthopedics
Institutions: Universitair Ziekenhuis Leuven, KU Leuven
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W4415789383