Increased identification of parathyroid glands using near infrared light during thyroid and parathyroid surgery

Falcó, Jorge; Dip, Fernando; Quadri, Pablo; Fuente, Martin De La; Prunello, Marcos; Rosenthal, Raúl J.

doi:10.1007/s00464-017-5424-1

Cited by 82 publications

(76 citation statements)

References 16 publications

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“…23 Again without administering any dye, Kim and colleagues 24 reported that they were able to benefit from the intrinsic fluorophores of parathyroid tissue to preoperatively identify all 16 parathyroid glands they sought in their patients. 25 Falco and colleagues 16 have also reported that parathyroid visualization increased when NIRL, rather than WL, was used (p ¼ 0.026); in their study, consistent with our own, covariates like patient sex, age, and primary diagnosis exerted no influence on the intensity of fluorescence in tissues surrounding the parathyroid glands, including the thyroid glands and other adjacent tissues. 16 In the current study, we discovered, first, that surgeons were able to identify as many parathyroid glands using NIRL before thyroid dissection as they were able to identify under WL after the thyroidectomy was completed; and, second, that using NIRL before thyroid dissection was significantly more effective at identifying parathyroid glands than using WL, with NIRL revealing at least 1 otherwise-missed gland in 2 of every 3 patients, and a mean of 1.0 missed gland per patient overall.…”

Section: Discussionsupporting

confidence: 87%

“…25 Falco and colleagues 16 have also reported that parathyroid visualization increased when NIRL, rather than WL, was used (p ¼ 0.026); in their study, consistent with our own, covariates like patient sex, age, and primary diagnosis exerted no influence on the intensity of fluorescence in tissues surrounding the parathyroid glands, including the thyroid glands and other adjacent tissues. 16 In the current study, we discovered, first, that surgeons were able to identify as many parathyroid glands using NIRL before thyroid dissection as they were able to identify under WL after the thyroidectomy was completed; and, second, that using NIRL before thyroid dissection was significantly more effective at identifying parathyroid glands than using WL, with NIRL revealing at least 1 otherwise-missed gland in 2 of every 3 patients, and a mean of 1.0 missed gland per patient overall. We also observed that the incidence of hypocalcemia postoperatively among patients in whom NIRL was used was half that observed among those for whom surgeons used WL only, and that the incidence of more severe levels of hypocalcemia was even more markedly reduced.…”

Section: Discussionsupporting

confidence: 87%

“…[13][14][15] Variables like patient sex, age, and primary diagnosis exerted no influence on the fluorescent intensity of surrounding tissues, including thyroid. 16 However, to our knowledge, few controlled data have been published documenting actual reductions in post-thyroidectomy hypocalcemia incidence when NIRL is used as a parathyroid identification tool, and these were within-rather than betweensubject comparisons. 16 The current randomized controlled trial had 2 primary aims: to compare the effectiveness of using NIRL with WL during total thyroidectomies to identify parathyroid glands earlier in the procedure, and to evaluate the effectiveness of NIRL again relative to WL as a means to reduce the incidence of postoperative hypocalcemia.…”

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confidence: 99%

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Randomized Controlled Trial Comparing White Light with Near-Infrared Autofluorescence for Parathyroid Gland Identification During Total Thyroidectomy

Dip

Falcó

Verna

et al. 2019

Journal of the American College of Surgeons

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114

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BACKGROUND: Parathyroid glands are difficult to identify during total thyroidectomies, and accidental resection can lead to problematic postoperative hypocalcemia. Our main goals were to evaluate the effectiveness of using near-infrared light (NIRL) autofluorescence intraoperatively for parathyroid gland identification and to measure its impact on postoperative hypocalcemia incidence. STUDY DESIGN: Total thyroidectomies were performed on 170 patients with different thyroid pathologies, block-randomized (1:1) into 2 equal groups. Among controls, traditional overhead white light (WL) was used throughout. In the experimental group, NIRL was used to enhance parathyroid gland recognition before thyroid dissection. The number of parathyroid glands identified was compared after thyroid dissection in controls using WL vs pre-dissection in the experimental using NIRL and with WL vs NIRL before thyroid dissection in the experimental group. Postoperative serum calcium levels and hypocalcemia rates were compared. RESULTS: The mean number of parathyroid glands identified pre-dissection with NIRL was the same identified post-dissection with WL (3.5 vs 3.6). In the experimental group, converting from WL to NIRL increased the number of glands detected from 2.6 to 3.5 (p < 0.001), and revealed at least 1 previously missed gland in 67.1% of patients. Calcium levels 7.5 mg/dL were one-tenth as common in the NIRL group (p ¼ 0.005). The adjusted odds of hypocalcemia developing increased by 15% for every 5-g increase in thyroid gland weight (odds ratio 1.15; 95% CI 1.06 to 1.25). All hypocalcemia resolved within 6 months. CONCLUSIONS: Using NIRL during thyroidectomy increases intraoperative identification of parathyroid glands, enhances their detection before thyroid dissection, and decreases the incidence of postoperative hypocalcemia.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 87%

mentioning

confidence: 99%

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Randomized Controlled Trial Comparing White Light with Near-Infrared Autofluorescence for Parathyroid Gland Identification During Total Thyroidectomy

Dip

Falcó

Verna

et al. 2019

Journal of the American College of Surgeons

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114

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“…If the frequency of permanent hypoparathyroidism in children is high even in the hands of experienced high-volume surgeons new efforts must be taken to try to change this situation. Maybe new methods such as infrared light during thyroid surgery could be one tool [21]. The frequency of parathyroid autotransplantation was 37–40% in this study.…”

Section: Discussionmentioning

confidence: 64%

Permanent Hypoparathyroidism After Total Thyroidectomy in Children: Results from a National Registry

2018

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IntroductionHypoparathyroidism is the most common complication following thyroidectomy. There are few population-based reports on the rate of hypoparathyroidism in children. The incidence of medical treatment of permanent hypoparathyroidism in children is reported using a national registry.MethodsThe study population included patients below 18 years of age undergoing total thyroidectomy reported to the Scandinavian Quality Registry for Thyroid, Parathyroid and Adrenal Surgery 2004–2014. Patients with previous thyroid or parathyroid surgery or treatment with vitamin D before surgery were excluded from analysis. Permanent postoperative hypoparathyroidism was defined as treatment with vitamin D for more than 6 months after thyroidectomy. Risk factors for permanent hypoparathyroidism were calculated with uni- and multivariable logistic regression. Using data from the Swedish Inpatient Registry, rates of readmissions and annual number of days in hospital after total thyroidectomy were compared between patients with and without permanent hypoparathyroidism.ResultsSome 274 children (215 girls and 59 boys) underwent total thyroidectomy. The median age was 14 (range 0–17) years. Indications for surgery were Graves’ disease (214, 78.1%), other benign disease (27, 9.9%) and thyroid cancer (33, 12%). Median follow-up was 4.8 years. Twenty (7.3%) children developed permanent hypoparathyroidism. No statistically significant risk factors for permanent hypoparathyroidism were identified. Rates of readmission and annual number of days in hospital after discharge were similar in patients with and without permanent hypoparathyroidism.ConclusionsThe rate of permanent hypoparathyroidism following total thyroidectomy in children was high and is a cause of concern.

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“…Depending on the surgeon, 37%-67% of PTGs were identified intraoperatively by NIR AFI even without previous dissection and visual recognition [108]. Falco et al found significantly higher PTG detection rates by NIR compared to standard resection under white light in a group of 74 patients undergoing thyroid and parathyroid surgery [109]. In a comparative study of the dye-based indocyanine green (ICG) fluorescence imaging with NIR AFI, both techniques reached similar detection rates [110].…”

Section: Af Of the Thyroid And Parathyroid Glandsmentioning

confidence: 99%

Recent Advances and the Potential for Clinical Use of Autofluorescence Detection of Extra-Ophthalmic Tissues

et al. 2020

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The autofluorescence (AF) characteristics of endogenous fluorophores allow the label-free assessment and visualization of cells and tissues of the human body. While AF imaging (AFI) is well-established in ophthalmology, its clinical applications are steadily expanding to other disciplines. This review summarizes clinical advances of AF techniques published during the past decade. A systematic search of the MEDLINE database and Cochrane Library databases was performed to identify clinical AF studies in extra-ophthalmic tissues. In total, 1097 articles were identified, of which 113 from internal medicine, surgery, oral medicine, and dermatology were reviewed. While comparable technological standards exist in diabetology and cardiology, in all other disciplines, comparability between studies is limited due to the number of differing AF techniques and non-standardized imaging and data analysis. Clear evidence was found for skin AF as a surrogate for blood glucose homeostasis or cardiovascular risk grading. In thyroid surgery, foremost, less experienced surgeons may benefit from the AF-guided intraoperative separation of parathyroid from thyroid tissue. There is a growing interest in AF techniques in clinical disciplines, and promising advances have been made during the past decade. However, further research and development are mandatory to overcome the existing limitations and to maximize the clinical benefits.

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Increased identification of parathyroid glands using near infrared light during thyroid and parathyroid surgery

Abstract: The use of NIRL for PG visualization significantly increased the number of PGs identified during thyroid and parathyroid surgery, and the differences in fluorescent intensity among PGs, thyroid glands, and background were not affected by age, sex, and histopathological diagnosis.

Cited by 82 publications

References 16 publications

Randomized Controlled Trial Comparing White Light with Near-Infrared Autofluorescence for Parathyroid Gland Identification During Total Thyroidectomy

Randomized Controlled Trial Comparing White Light with Near-Infrared Autofluorescence for Parathyroid Gland Identification During Total Thyroidectomy

Permanent Hypoparathyroidism After Total Thyroidectomy in Children: Results from a National Registry

Recent Advances and the Potential for Clinical Use of Autofluorescence Detection of Extra-Ophthalmic Tissues

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