Effect of near infrared autofluorescence guided total thyroidectomy on postoperative hypoparathyroidism: a randomized clinical trial

Lykke, Eva; Christensen, Anders; Juhl, Karina; Feldt‐Rasmussen, Ulla; Hitz, Mette Friberg; Sjöstedt, Sven; Hahn, Christoffer Holst; Svensson, Ditte Maria Kraik; Springborg, Karoline; Stage, Mads Georg; Hvilsom, Gitte Bjørn; Hilsted, Linda; Dahl, Morten; Lelkaitis, Giedrius; Kjær, Andreas; Homøe, Preben; Buchwald, Christian von

doi:10.1007/s00405-023-07867-4

Cited by 9 publications

(14 citation statements)

References 44 publications

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“…Both Dip et al 27 and Benmiloud et al 25 showed a reduction in immediate hypocalcemia, but not in permanent hypocalcemia. In the studies by DiMarco et al, 37 Lykke et al, 30 and Bergenfelz et al, 38 no statistically significant change was reported for either immediate or permanent hypoPT. The overall absence of reduction in the rates of permanent hypoPT in these studies can probably be ascribed to the fact that their permanent hypoPT rates were relatively low.…”

Section: Discussionmentioning

confidence: 92%

“…The mean (SD) duration of surgery was higher when NIRAF was used compared with the control group (NIRAF: 137 [30] minutes vs control: 116 [28] minutes; P < .001) (Table 2). Patients who underwent NIRAF-guided surgery also had a significantly shorter median (IQR) hospital stay than controls (NIRAF: 2 [1-3] days vs control: 3 [2-4] days; P < .001).…”

Section: Jama Network Open | Surgerymentioning

confidence: 99%

“…13,14,17,[22][23][24] In recent years, the use of intraoperative near-infrared autofluorescence (NIRAF) during thyroid surgery has gained traction. [25][26][27][28][29][30] Near-infrared autofluorescence refers to PGs ability to fluoresce when excited with light at the near-infrared wavelength of 785 nm. 31 Thus, NIRAF holds the potential to facilitate intraoperative PG visualization.…”

Section: Introductionmentioning

confidence: 99%

“…In recent years, the use of intraoperative near-infrared autofluorescence (NIRAF) during thyroid surgery has gained traction . Near-infrared autofluorescence refers to PGs ability to fluoresce when excited with light at the near-infrared wavelength of 785 nm .…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 92%

Section: Jama Network Open | Surgerymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Abood,

Rolighed,

Triponez

et al. 2024

JAMA Netw Open

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“…After a full-text analysis of the remaining 19 articles, 10 papers were rejected due to being a prospective comparative study (n = 4), case-control study (n = 2), cohort study (n = 2), and retrospective study (n = 2). Finally, nine randomised controlled studies comparing NIRAF with non-NIRAF use in thyroidectomy [ 8 , 9 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ] were included for meta-analysis.…”

Section: Resultsmentioning

confidence: 99%

Lower Rates of Hypocalcemia Following Near-Infrared Autofluorescence Use in Thyroidectomy: A Meta-Analysis of RCTs

Rao,

Rajguru,

Dange

et al. 2024

Diagnostics

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Background: Iatrogenic injury of the parathyroid glands is the most frequent complication after total thyroidectomy. Objective: To determine the effectiveness of near-infrared autofluorescence (NIRAF) in reducing postoperative hypocalcemia following total thyroidectomy. Methods: PubMed, Scopus, and Google Scholar databases were searched. Randomised trials reporting at least one hypocalcemia outcome following total thyroidectomy using NIRAF were included. Results: The qualitative data synthesis comprised 1363 patients from nine randomised studies, NIRAF arm = 636 cases and non-NIRAF arm = 637 cases. There was a statistically significant difference in the overall rate of hypocalcemia log(OR) = −0.7 [(−1.01, −0.40), M-H, REM, CI = 95%] and temporary hypocalcemia log(OR) = −0.8 [(−1.01, −0.59), M-H, REM, CI = 95%] favouring the NIRAF. The difference in the rate of permanent hypocalcemia log(OR) = −1.09 [(−2.34, 0.17), M-H, REM, CI = 95%] between the two arms was lower in the NIRAF arm but was not statistically significant. Conclusions: NIRAF during total thyroidectomy helps in reducing postoperative hypocalcemia. Level of evidence—1.

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In-vivo and ex-vivo parathyroid autofluorescence overlay imaging is equally feasible using two different wavelengths (785 nm vs. 805 nm)

Arikan,

Hargitai,

Binter

et al. 2024

Current Problems in Surgery

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Effect of near infrared autofluorescence guided total thyroidectomy on postoperative hypoparathyroidism: a randomized clinical trial

Cited by 9 publications

References 44 publications

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

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

Lower Rates of Hypocalcemia Following Near-Infrared Autofluorescence Use in Thyroidectomy: A Meta-Analysis of RCTs

In-vivo and ex-vivo parathyroid autofluorescence overlay imaging is equally feasible using two different wavelengths (785 nm vs. 805 nm)

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