Association of Autofluorescence-Based Detection of the Parathyroid Glands During Total Thyroidectomy With Postoperative Hypocalcemia Risk

Benmiloud, Fares; Godiris-Petit, G.; Gras, Régis; Gillot, Jean-Charles; Turrin, Nicolas P.; Pénaranda, Guillaume; Noullet, S.; Chéreau, Nathalie; Gaudart, Jean; Chiche, Laurent; Rebaudet, Stanislas

doi:10.1001/jamasurg.2019.4613

Cited by 143 publications

(183 citation statements)

References 21 publications

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“…Although the French studies reported less hypocalcemia, as defined as <8 mg/dL on POD#1 and 2, 8,19 the Argentinian study showed less severe (<7.6 mg/dL) hypocalcemia with the use of NIFI 20 . None of the studies showed any differences in long‐term hypocalcemia rates 8,19,20 . In the current study, the mean number of parathyroid glands recognized intraoperatively was the same between the NIFI and conventional surgery groups and 1/3 of the parathyroid glands were seen on NIFI first before they became apparent to the eye.…”

Section: Discussioncontrasting

confidence: 60%

“…Furthermore, there is a suggestion that there was less incidence of inadvertent parathyroidectomies and parathyroid autotransplantations with NIFI versus conventional surgery 8,19 . Although the French studies reported less hypocalcemia, as defined as <8 mg/dL on POD#1 and 2, 8,19 the Argentinian study showed less severe (<7.6 mg/dL) hypocalcemia with the use of NIFI 20 . None of the studies showed any differences in long‐term hypocalcemia rates 8,19,20 .…”

Section: Discussionmentioning

confidence: 97%

“…Furthermore, they reported the inadvertent parathyroid resection rate to decrease from 7.2% to 1.1% and parathyroid autotransplantation rate to drop from 15% to 2.1% (per patient). The same group subsequently investigated the same question in a randomized fashion between 2016 and 2018 in three referral centers in France 19 . A total of 121 patients underwent NIFI‐assisted thyroidectomy and 120 patients conventional thyroidectomy.…”

Section: Discussionmentioning

confidence: 99%

“…When these studies are analyzed, it could be inferred that this technology may have increased the ability of the study surgeons to identify parathyroid glands when compared with the conventional technique that relies on visual surgical identification alone 8,19,20 . Furthermore, there is a suggestion that there was less incidence of inadvertent parathyroidectomies and parathyroid autotransplantations with NIFI versus conventional surgery 8,19 . Although the French studies reported less hypocalcemia, as defined as <8 mg/dL on POD#1 and 2, 8,19 the Argentinian study showed less severe (<7.6 mg/dL) hypocalcemia with the use of NIFI 20 .…”

Section: Discussionmentioning

confidence: 99%

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The impact of near infrared fluorescence imaging on parathyroid function after total thyroidectomy

Kim

Erten

Kahramangil

et al. 2020

Journal of Surgical Oncology

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Background Compared with conventional thyroidectomy, hypocalcemia rate was reported to be lower after total thyroidectomy (TT) utilizing near infrared fluorescence imaging (NIFI). The aim of this study is to evaluate the impact of NIFI on postoperative parathyroid function after TT. Methods This was a retrospective institutional review board‐approved study comparing 100 patients who underwent TT with NIFI guidance and 200 patients without, by the same surgeon. Clinical parameters were compared using χ2 and t test. Results Average number of parathyroid glands identified intraoperatively was similar between two groups. However, rate of incidental parathyroidectomy was higher in conventional (14%) versus NIFI group (6%) (P = .039), despite similar (4% vs 6%, respectively) autotransplantation rates (P = .562). Incidences of transient (6.5% vs 5.0%) and permanent (0.5% vs 0%) hypocalcemia were not statistically different between conventional and NIFI groups (P = NS). Conclusion The use of NIFI during thyroidectomy may decrease the rate of incidental parathyroidectomy by increasing the ability of the surgeon to recognize parathyroid glands with fluorescent contrast distinction. Nevertheless, in contrary to recent reports in literature, postoperative hypocalcemia rate was not altered compared with conventional technique, suggesting that preservation of parathyroid vasculature, rather than an augmented ability to detect the glands, may dominantly affect postoperative function.

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Section: Discussioncontrasting

confidence: 60%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The impact of near infrared fluorescence imaging on parathyroid function after total thyroidectomy

Kim

Erten

Kahramangil

et al. 2020

Journal of Surgical Oncology

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“…In addition, ICG has most recently emerged as a technique for assessing the vascularization of the parathyroid glands, which seems to be closely correlated with parathyroid function, after thyroid resection [22,[32][33][34][35][36]. From a technical point of view, the protocols and doses of dye used for ICG angiography differ from center to center, with the best dosage still under debate.…”

Section: Discussionmentioning

confidence: 99%

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

Demarchi

Karenovicŝ

Bédat

et al. 2020

JCM

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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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Autofluorescence-Guided Total Thyroidectomy in Low-Volume, Nonparathyroid Institutions

Abood,

Rolighed,

Triponez

et al. 2024

JAMA Netw Open

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ImportanceHypoparathyroidism following thyroid surgery is a serious complication that occurs frequently when surgery is performed by low-volume thyroid surgeons without experience in parathyroid surgery.ObjectiveTo evaluate the occurrence of hypoparathyroidism following total thyroidectomy after the introduction of autofluorescence in low-volume, nonparathyroid institutions.Design, Setting, and ParticipantsThis prospective, multicenter cohort study, with a follow-up period of up to 1 year, was conducted in Denmark at 2 low-volume nonparathyroid institutions between January 2021 and November 2023. All adult patients referred for total thyroidectomy were assessed for eligibility (n = 90). Only patients with no history of thyroid surgery were considered (n = 89). Patients who only underwent lobectomy (n = 6) or declined to participate (n = 5) were excluded. All included patients completed follow-up. The prospective cohort was compared with a historical cohort of successive patients undergoing primary total thyroidectomy from 2016 to 2020 (before autofluorescence was available).InterventionIncluded patients underwent autofluorescence-guided total thyroidectomy.Main outcomes and MeasuresRate of hypoparathyroidism. Immediate hypoparathyroidism was defined as the need for active vitamin D postoperatively, whereas permanent hypoparathyroidism was considered when there still was a need for active vitamin D 1 year after surgery.ResultsSeventy-eight patients underwent autofluorescence-guided surgery (mean [SD] age, 55.6 [13.1] years; 67 [86%] female) and were compared with 89 patients in the historical cohort (mean [SD] age, 49.7 [12.8] years; 78 [88%] female). The rate of immediate hypoparathyroidism decreased from 37% (95% CI, 27%-48%) to 19% (95% CI, 11%-30%) after the introduction of autofluorescence (P = .02). Permanent hypoparathyroidism rates decreased from 32% (95% CI, 22%-42%) to 6% (95% CI, 2%-14%) (P &lt; .001), reaching 0% at the end of the study. More parathyroid glands were identified with autofluorescence (75% [95% CI, 70%-80%] vs 61% [95% CI, 56%-66%]) (P &lt; .001) and less parathyroid glands were inadvertently excised (4% [95% CI, 1%-11%] vs 21% [95% CI, 13%-31%]) (P = .001).Conclusions and RelevanceIn this cohort study of autofluorescence-guided thyroid surgery in low-volume, nonparathyroid institutions, the use of autofluorescence was associated with a significant decrease in both immediate and permanent hypoparathyroidism. When autofluorescence was used, hypoparathyroidism rates were comparable with those of high-volume surgeons who also perform parathyroid surgery.

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Association of Autofluorescence-Based Detection of the Parathyroid Glands During Total Thyroidectomy With Postoperative Hypocalcemia Risk

Cited by 143 publications

References 21 publications

The impact of near infrared fluorescence imaging on parathyroid function after total thyroidectomy

The impact of near infrared fluorescence imaging on parathyroid function after total thyroidectomy

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

Autofluorescence-Guided Total Thyroidectomy in Low-Volume, Nonparathyroid Institutions

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