Spare Parathyroid Glands During Thyroid Surgery with Perioperative Autofluorescence Imaging: A Diagnostic Study

2021 ◽  
Author(s):  
Alexandre Bellier ◽  
Yann Wazne ◽  
Thibaut Chollier ◽  
Nathalie Sturm ◽  
Philippe Chaffanjon
Keyword(s):  
Thyroid Surgery ◽  
Parathyroid Glands ◽  
Diagnostic Study ◽  
Autofluorescence Imaging

Feasibility of Autofluorescence for Parathyroid Glands During Thyroid Surgery and the Risk of Hypocalcemia: First Results in Belgium and Review of the Literature

2020 ◽  
pp. 155335062098026
Author(s):  
Sam Van Slycke ◽  
Klaas Van Den Heede ◽  
Nele Brusselaers ◽  
Hubert Vermeersch
Keyword(s):  
Total Thyroidectomy ◽  
Thyroid Surgery ◽  
Standard Technique ◽  
Parathyroid Glands ◽  
The Other ◽  
Endocrine Surgery ◽  
Autofluorescence Imaging ◽  
Tertiary Referral Centre ◽  
Potential Clinical Benefit ◽  
First Results

Background. Post-operative hypocalcemia remains the most frequent complication after total thyroidectomy. Recently, autofluorescence imaging was introduced to detect parathyroid glands early during dissection. Aim. We aimed to check the feasibility of autofluorescence regarding the number of parathyroid glands visualised and the risk of post-operative hypocalcemia. Methods. In a prospectively gathered cohort of patients undergoing thyroid surgery, we describe the risk of hypocalcemia in relation to the number of parathyroid glands visualised during surgery (and the risk reported in the scientific literature) and the feasibility to obtain an autofluorescence of the parathyroid glands. Results. From 2010 to 2019, 1083 patients were referred for total thyroidectomy in our tertiary referral centre for endocrine surgery, of which, 40 consecutive cases were operated using autofluorescence. Among the autofluorescence group, 14 (35.0%) had all 4 parathyroid glands visualised, compared to 147 (14.1%) in the other patients, without differences in the number of parathyroid glands reimplanted. No permanent hypocalcemia occurred in the autofluorescence group and 17.5% temporary hypoparathyroidism, compared to 3.1% and 31.9% among the other patients, and 4% (95% confidence interval [CI] 3–5%) and 19% (95% CI 15–24%) in the literature. Conclusion. Autofluorescence imaging provides reliable real-time visualisation at any point during thyroid surgery and helps to identify the parathyroid glands before detection with the naked eye. To date, it cannot be used as a standard technique and does not replace meticulous dissection. To become a useful adjunct in peroperative parathyroid management, large multicentre studies need to establish a potential clinical benefit of this novel technique.

scholarly journals Evaluation of Autofluorescence in Identifying Parathyroid Glands by Measuring Parathyroid Hormone in Fine-Needle Biopsy Washings

2021 ◽  
Author(s):  
Zhen liu ◽  
Run-sheng Ma ◽  
Jun-li Jia ◽  
Tao Wang ◽  
Dao-hong Zuo ◽  
...  
Keyword(s):  
Lymph Node ◽  
Parathyroid Hormone ◽  
Lymph Nodes ◽  
Thyroid Surgery ◽  
Near Infrared ◽  
Parathyroid Glands ◽  
Autofluorescence Imaging ◽  
Node Dissection ◽  
Fine Needle ◽  
Intraoperative Parathyroid Hormone

Abstract Background: Near-infrared autofluorescence imaging has potentially great value for assisting endocrine surgeons in identifying parathyroid glands and may dramatically change the surgical strategy of endocrine surgeons in thyroid surgery. This study is designed to objectively evaluate the role of near-infrared autofluorescence imaging in identifying parathyroid glands during thyroid surgery by measuring intraoperative parathyroid hormone in fine-needle aspiration biopsy washings.Methods: A case series study was conducted at a tertiary referral teaching hospital in China from September 2019 to April 2020. Patients undergoing total thyroidectomy with or without neck lymph node dissection were consecutively included. The surgeon used near-infrared autofluorescence imaging to identify parathyroid glands during thyroid surgery and confirmed suspicious parathyroid tissues by measuring their intraoperative parathyroid hormone. Nanocarbon was injected into the thyroid gland if the thyroid autofluorescence intensity was too strong. The sensitivity and accuracy of near-infrared autofluorescence imaging and vision for identifying parathyroid glands, and the difference in autofluorescence intensity in various tissues were the main outcomes.RESULTS: Overall, 238 patients completed the trial. Based on the pathological and aIOPTH results, the sensitivity of near-infrared autofluorescence imaging for detecting parathyroid glands（568 of 596 parathyroid glands; 95.30%）was significantly higher than that of vision（517 of 596 parathyroid glands; 86.74%, P<.001). The accuracy of near-infrared autofluorescence imaging (764 of 841 tissues; 90.84%) was significantly higher than that of vision (567 of 841 tissues; 67.42%, P<.001) when the evaluations of certain tissues were inconsistent. There was a significant difference between the autofluorescence intensity of the parathyroid glands and that of the lymph nodes (74.19 ± 17.82 vs 33.97 ± 10.64, P<.001).CONCLUSIONS: The use of near-infrared autofluorescence imaging, along with intraoperative parathyroid hormone and nanocarbon for the identification of parathyroid glands in thyroid surgery may increase the number of confirmed parathyroid glands. Using near-infrared autofluorescence imaging can effectively distinguish lymph nodes and parathyroid glands during lymph node dissection.

scholarly journals Fluorescence Image-Guided Surgery for Thyroid Cancer: Utility for Preventing Hypoparathyroidism

Cancers ◽  
2021 ◽  
Vol 13 (15) ◽  
pp. 3792
Author(s):  
Marco Stefano Demarchi ◽  
Barbara Seeliger ◽  
Jean-Christophe Lifante ◽  
Pier Francesco Alesina ◽  
Frédéric Triponez
Keyword(s):  
Thyroid Cancer ◽  
Fluorescence Imaging ◽  
Thyroid Surgery ◽  
Parathyroid Glands ◽  
Review Of The Literature ◽  
Inclusion Criteria ◽  
Fluorescence Image ◽  
Guided Surgery ◽  
Fluorescence Guided Surgery

Background: Hypoparathyroidism is one of the most frequent complications of thyroid surgery, especially when associated with lymph node dissection in cases of thyroid cancer. Fluorescence-guided surgery is an emerging tool that appears to help reduce the rate of this complication. The present review aims to highlight the utility of fluorescence imaging in preserving parathyroid glands during thyroid cancer surgery. Methods: We performed a systematic review of the literature according to PRISMA guidelines to identify published studies on fluorescence-guided thyroid surgery with a particular focus on thyroid cancer. Articles were selected and analyzed per indication and type of surgery, autofluorescence or exogenous dye usage, and outcomes. The Methodological Index for Non-Randomized Studies (MINORS) was used to assess the methodological quality of the included articles. Results: Twenty-five studies met the inclusion criteria, with three studies exclusively assessing patients with thyroid cancer. The remaining studies assessed mixed cohorts with thyroid cancer and other thyroid or parathyroid diseases. The majority of the papers support the potential benefit of fluorescence imaging in preserving parathyroid glands in thyroid surgery. Conclusions: Fluorescence-guided surgery is useful in the prevention of post-thyroidectomy hypoparathyroidism via enhanced early identification, visualization, and preservation of the parathyroid glands. These aspects are notably beneficial in cases of associated lymphadenectomy for thyroid cancer.

Cutting Edge in Thyroid Surgery: Autofluorescence of Parathyroid Glands

2016 ◽  
Vol 223 (2) ◽  
pp. 374-380 ◽  
Author(s):  
Jorge Falco ◽  
Fernando Dip ◽  
Pablo Quadri ◽  
Martin de la Fuente ◽  
Raul Rosenthal
Keyword(s):  
Thyroid Surgery ◽  
Cutting Edge ◽  
Parathyroid Glands

Arterial blood supply to the parathyroid glands: Implications for thyroid surgery

1982 ◽  
Vol 3 (3) ◽  
pp. 279-287 ◽  
Author(s):  
J. B. Flament ◽  
J. F. Delattre ◽  
M. Pluot
Keyword(s):  
Blood Supply ◽  
Thyroid Surgery ◽  
Parathyroid Glands ◽  
Arterial Blood Supply ◽  
Arterial Blood

scholarly journals Comparison between Magnification Techniques and Direct Vision in Thyroid Surgery: A Systematic Review and Meta-Analysis

Medicina ◽  
2019 ◽  
Vol 55 (11) ◽  
pp. 725 ◽  
Author(s):  
Sapalidis ◽  
Papanastasiou ◽  
Fyntanidou ◽  
Aidoni ◽  
Michalopoulos ◽  
...  
Keyword(s):  
Systematic Review ◽  
Thyroid Surgery ◽  
Meta Analysis ◽  
Parathyroid Glands ◽  
Direct Vision ◽  
Cochrane Library ◽  
Surgical Microscope ◽  
Randomized Controlled ◽  
Permanent Hypocalcemia ◽  
October 17

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 (0.11–1.35), I2 = 0%) and transient hypocalcemia (OR = 0.31, 95% CI (0.09–1.09), 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.

scholarly journals A new classification of parathyroid glands to evaluate in situ preservation or autotransplantation during thyroid surgery

Medicine ◽  
2018 ◽  
Vol 97 (48) ◽  
pp. e13231 ◽  
Author(s):  
Anping Su ◽  
Yanping Gong ◽  
Tao Wei ◽  
Rixiang Gong ◽  
Zhihui Li ◽  
...  
Keyword(s):  
Thyroid Surgery ◽  
Parathyroid Glands ◽  
New Classification ◽  
In Situ Preservation

scholarly journals Intraoperative Autofluorescence and Indocyanine Green Angiography for the Detection and Preservation of Parathyroid Glands

2020 ◽  
Vol 9 (3) ◽  
pp. 830 ◽  
Author(s):  
Marco Stefano Demarchi ◽  
Wolfram Karenovics ◽  
Benoît Bédat ◽  
Frédéric Triponez
Keyword(s):  
Thyroid Surgery ◽  
Near Infrared ◽  
Infrared Imaging ◽  
Parathyroid Tissue ◽  
Parathyroid Glands ◽  
Endocrine Surgery ◽  
Near Infrared Imaging ◽  
Postoperative Hypoparathyroidism

Fluorescence imaging is a well-known method for both the in vivo and in vitro identification of specific cells or tissues. This imaging tool is gaining importance in the intraoperative detection and preservation of parathyroid glands during endocrine surgery owing to the intrinsic properties of parathyroid tissue. The aim of this paper is to provide an overview of the basics of the technology, its history, and the recent surgical intraoperative applications of near-infrared imaging methods. Moreover, a literature review of the utilization of fluorescence devices in thyroid surgery suggests that the use of near-infrared imaging seems to be beneficial in reducing postoperative hypoparathyroidism, which is one of the most frequent complications of thyroid surgery.

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