High magnification versus optical magnification in hypospadias surgery: a randomized controlled trial

Abstract Background Hypospadias is the most common congenital abnormality of the urethra affecting live male births. The incidence is rising with the increasing pollution. During the last 50 years, developments in surgical instrumentation and optical systems allowed surgeons to increasingly undertake microsurgical procedures. Optical magnification is essential in pediatric surgery. Magnifying loupes are the most frequently used, although they often cause neck pain to the surgeon. Recent advances led to the development of a compact video microscope (VITOM; Karl Storz Endoscopy GmbH, Tuttlingen, Germany) that displays high-definition magnified images on a flat screen. Objective Evaluate VITOM as a potential substitute for loupes in complex open pediatric procedures and explore VITOM as an effective intraoperative teaching modality for open surgery. Methods Fifty-two patients enrolled in our study were divided into two groups: Group A (26): high magnification was used either (VITOM Karl Storz Endoscopy GmbH, Tuttlingen, Germany) or (Surgical microscope, Carl Zeiss Microscopy GmbH), along with microsurgical instruments. Vicryl 8-0 suture was used for urethroplasty. Group B (26): patients were operated upon by conventional instruments (fine tip but not microsurgical instruments), sutures, and magnification (3.5×). Vicryl 6-0 suture was used for urethroplasty, with loupes-assisted magnification. Results More complications were found in group B. Using VITOM was accompanied by less neck pain, enhanced visualization, and an enhanced teaching environment. Conclusion Operating with high magnification tools minimizes post-operative complications in hypospadias surgery. They enhanced identification of the penile anatomy and topography which facilitated reconstruction techniques as well as enhanced the comfort of the surgeon. Level of evidence I.