Indocyanine Green Angiography in Subtotal Parathyroidectomy: Technique for the Function of the Parathyroid Remnant

A reappraisal of vascular anatomy of the parathyroid gland based on fluorescence techniques

“…In our initial experience using ICG to evaluate intraoperative perfusion of the PGs for the prediction of parathyroid function after thyroidectomy (45), we demonstrated that the presence of one well-perfused PG or a well-perfused PG remnant was sufficient to avoid hypoparathyroidism (46). After total thyroidectomy, we found that at least one well-perfused gland was present on angiography in 30 of 36 patients; none of the 30 patients experienced postoperative hypoparathyroidism.…”

“…Therefore, in those patients with less than 4 evaluated PGs, the perfusion and function of the non-visualized PGs remain unknown, obscuring a clear correlation between ICG perfusion (evaluated in 1, 2 or 3 PGs) and postoperative PTH levels (reflecting the function of all 4 PGs). We therefore analyzed patients undergoing subtotal parathyroidectomy (49) and reported our findings on ICG use in a prospective study of 13 patients undergoing subtotal parathyroidectomy for multiglandular disease (primary and secondary hyperparathyroidism) (46). Our goal was to determine …”

The use of ICG enhanced fluorescence for the evaluation of parathyroid gland preservation

“…In the past, inspection and palpation have been the main tools of a surgeon during surgery. Although all surgeons operate with careful dissection, there are still some limitations regarding organs or structural preservation in endocrine surgical procedures, especially parathyroid gland (PTG) preservation which we can see from the high incidence of postoperative parathyroid insufficiency in thyroid surgery (1) and uncertainty of parathyroid function after subtotal parathyroidectomy (2).…”

“…Previous research studies have shown the use of a particular technique or combination of techniques that have enabled surgeons to ensure the parathyroid remnant is adequately perfused, allowing for the total resection of the other PTGs to be carried out or to ensure that the PTGs are adequately vascularized after thyroid resection. This technique is used to reduce the chances of hypoparathyroidism after a patient undergoes thyroid surgery and can help to preserve postoperative parathyroid remnant function (2,3). We reviewed the current studies of ICG in endocrine surgery focusing on parathyroid preservation within this report.…”

“…There are several variables in terms of how each of the systems differ from one another, including such factors as the wavelength and bandwidth of excitation sources, required power input, and techniques employed for the filtration for the rejection of backscattered excitation and ambient light that influence the sensitivity levels of such device, as outlined in Table 1 (15). Recently, ICG fluorescence imaging was used with endocrine surgery, including thyroid and parathyroid surgery. Its use has been studied by several groups (2,(17)(18)(19)(20)(21)(22). However, an overall consensus on the optimal dosage and timing of ICG administration is still lacking.…”