<i>In situ</i> preservation of the inferior parathyroid gland during central neck dissection for papillary thyroid carcinoma

Wang, J B; Wu, Kunlin; Shi, Liuhong; Sun, Yungang; Li, F B; Xie, Liping

doi:10.1002/bjs.10581

Cited by 20 publications

(18 citation statements)

References 17 publications

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“…Energy devices should not be used too close to the parathyroid glands. Recent articles deal with technical tips to ensure preservation of the parathyroid glands along with their subtle vascular supply [ 67 , 68 ].…”

Section: Some Technical Hintsmentioning

confidence: 99%

Etiology and Diagnosis of Permanent Hypoparathyroidism after Total Thyroidectomy

Sitges‐Serra

2021

JCM

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Postoperative parathyroid failure is the commonest adverse effect of total thyroidectomy, which is a widely used surgical procedure to treat both benign and malignant thyroid disorders. The present review focuses on the scientific gap and lack of data regarding the time period elapsed between the immediate postoperative period, when hypocalcemia is usually detected by the surgeon, and permanent hypoparathyroidism often seen by an endocrinologist months or years later. Parathyroid failure after thyroidectomy results from a combination of trauma, devascularization, inadvertent resection, and/or autotransplantation, all resulting in an early drop of iPTH (intact parathyroid hormone) requiring replacement therapy with calcium and calcitriol. There is very little or no role for other factors such as vitamin D deficiency, calcitonin, or magnesium. Recovery of the parathyroid function is a dynamic process evolving over months and cannot be predicted on the basis of early serum calcium and iPTH measurements; it depends on the number of parathyroid glands remaining in situ (PGRIS)—not autotransplanted nor inadvertently excised—and on early administration of full-dose replacement therapy to avoid hypocalcemia during the first days/weeks after thyroidectomy.

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Section: Some Technical Hintsmentioning

confidence: 99%

Etiology and Diagnosis of Permanent Hypoparathyroidism after Total Thyroidectomy

Sitges‐Serra

2021

JCM

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“…A retrospective chart review was authorized and drawn from all 487 patients with PTC who underwent TT with ipsilateral or bilateral CND or plus lateral neck dissection between January 1, 2012 and December 31, 2014 [15]. The study group consisted of 181 patients with using the new surgical concept "a layer of TBP," from January 2014 to December 2014, whereas the control group included 306 sex-and age-matched patients who underwent conventional method from January 2012 to December 2013.…”

Section: Clinical Application Results Of "A Layer Of Tbp"mentioning

confidence: 99%

“…To solve this main problem, "a layer of TBP" was firstly put forward by Lei Xie in 2014 [15]. This new concept has two meanings: (1) the thymus, IPTG and blood vessels connecting them are located in one layer; (2) the layer covers the common carotid artery (innominate artery), the trachea, and the area of paratracheal lymph nodes between them (Figure 7).…”

Section: The Meanings Of "A Layer Of Tbp"mentioning

confidence: 99%

Inferior Parathyroid Gland Preservation In Situ during Central Neck Dissection for Thyroid Papillary Carcinoma

Xie¹,

Wang²,

Zhou³

2019

Thyroid Disorders

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Hypoparathyroidism is the most common and a potentially serious complication of thyroid surgery; therefore, it becomes very important for thyroid surgeons to preserve the parathyroid glands in situ during the thyroid operation. Because of the application of "meticulous capsular dissection," the problem about how to preserve the parathyroid gland in thyroidectomy has become minor. Because inferior parathyroid glands enjoy a more variable position in the adult neck and they are located in the area of central neck lymph node dissection, how to preserve them in situ during central neck dissection is regarded as a major problem. To solve it, a new operation concept, "a layer of thymusblood vessel-inferior parathyroid gland," is mainly introduced in this chapter.

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“…PG identification is the first step in protecting the PG during thyroid surgery (31). Almost all of the present PG protection strategies are based on PG identification (11,12,15). Benmiloud et al indicated that NIRAF helps to identify PGs (29).…”

Section: Discussionmentioning

confidence: 99%

“…Although some strategies have been proposed to prevent postoperative hypoparathyroidism, such as meticulous capsule dissection, preservation of the inferior thyroid vein, and classification of PG for functional protection, PG identification is crucial during thyroid surgery (11)(12)(13)(14). Several tracers were reported to assist in identifying the PG, but they have some disadvantages, such as lack of direct evidence and limitation of instrument and/or invasiveness, and surgeon-dependent identification is still pivotal after using them (11,15,16).…”

Section: Introductionmentioning

confidence: 99%

The Ability of Near-Infrared Autofluorescence to Protect Parathyroid Gland Function During Thyroid Surgery: A Meta-Analysis

et al. 2021

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ObjectiveWe conducted this meta-analysis to assess the ability of near-infrared autofluorescence to protect parathyroid gland function during thyroid surgery.MethodA systematic literature search was conducted using PubMed, Embase, and the Cochrane Library electronic databases for studies published up to February 2021. The reference lists of the retrieved articles were also reviewed. Two authors independently assessed methodological quality and extracted the data. A random-effects model was used to calculate the overall pooled variable and the weighted mean deviation. Publication bias in these studies was evaluated using the Egger’s and Begg’s tests.ResultSeven studies involving 1,480 patients were included in the analysis. Compared with patients in the naked eye group, the pooled relative risk of inadvertent parathyroid gland resection and parathyroid gland autotransplantation for the patients in the near-infrared autofluorescence group was 0.48 (95% CI, 0.26–0.9, p = 0.023) and 0.39 (95% CI, 0.09–1.68, p = 0.208), respectively. The pooled relative risk of hypocalcemia at 1 day postoperatively and at 6 months postoperatively for the patients in the near-infrared autofluorescence group was 0.49 (95% CI, 0.34–0.71, p < 0.001) and 0.34 (95% CI, 0.06–2.03, p = 0.238) compared with patients in the naked eye group.ConclusionNear-infrared autofluorescence is significantly associated with a reduced risk of inadvertent parathyroid gland resection and hypocalcemia at 1 day postoperatively.

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In situ preservation of the inferior parathyroid gland during central neck dissection for papillary thyroid carcinoma

Abstract: Applying the proposed surgical concept improved the rate of inferior parathyroid gland preservation in situ and decreased the incidence of transient postoperative hypoparathyroidism.

Cited by 20 publications

References 17 publications

Etiology and Diagnosis of Permanent Hypoparathyroidism after Total Thyroidectomy

Etiology and Diagnosis of Permanent Hypoparathyroidism after Total Thyroidectomy

Inferior Parathyroid Gland Preservation In Situ during Central Neck Dissection for Thyroid Papillary Carcinoma

The Ability of Near-Infrared Autofluorescence to Protect Parathyroid Gland Function During Thyroid Surgery: A Meta-Analysis

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