Intraoperative localization of the parathyroid glands with indocyanine green and Firefly(R) technology during BABA robotic thyroidectomy

Yu, Hyeong Won; Chung, Joon Woo; Yi, Jin Wook; Song, Ra Yeong; Lee, Joon Hyop; Kwon, Hyungju; Kim, Su jin; Chai, Young Jun; Choi, June Young; Lee, Kyu Eun

doi:10.1007/s00464-016-5330-y

Cited by 76 publications

(68 citation statements)

References 22 publications

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“…4 In this study, however, ICG was injected into the thyroid parenchyma and reached the LNs through the lymphatics. Thus, ICG uptake by the parathyroid glands was relatively lower than that of the LN.…”

Section: Discussionmentioning

confidence: 96%

Early Experience and the Feasibility of the Firefly Technology for Central Lymph Node Dissection (CLND) in Robotic Thyroidectomy Using the BABA

Choi

Lee

Jung

et al. 2017

J Minim Invasive Surg

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In the bilateral axillo-breast approach (BABA), the camera is inserted through the areolar incision, and this raises the concern it might be difficult to identify the lymph nodes (LN). The purpose of this study is to evaluate the feasibility of the Firefly for central lymph node dissection (CLND) in robotic thyroidectomy using the BABA. This study evaluated 18 patients who underwent robotic surgery using Firefly between December 2015 and March 2016. For LN mapping, 0.05 ml of ICG was injected into the thyroid 3~4 minutes before CLND. Green-stained LN could be detected easily through a near-infrared camera. The number of retrieved LNs was 7.8±3.0 after CLND using the Firefly, which was higher than the 6.7±0.2 reported in previous surgeries. In addition, it helped to distinguish between the parathyroid and the LNs. The Firefly technology was helpful in identifying the LNs, guiding the CLND and performing a complete CLND.

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Section: Discussionmentioning

confidence: 96%

Early Experience and the Feasibility of the Firefly Technology for Central Lymph Node Dissection (CLND) in Robotic Thyroidectomy Using the BABA

Choi

Lee

Jung

et al. 2017

J Minim Invasive Surg

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“…Studies have been going on for locating and predicting function of PGs with indocyanine green (ICG) fluorescent imaging in both thyroid and parathyroid surgery (46)(47)(48)(49)(50)(51)(52). ICG is a water-soluble molecule that binds to plasma protein and confined to intravascular compartment.…”

Section: Assessing Viability Of In Situ Pgsmentioning

confidence: 99%

“…It will emit fluorescent light when being excited by near-infrared light (NIR); thus, the combination of ICG and NIR may provide real-time assessment on tissue perfusion within a focused area reflected by the fluorescent light intensity. ICG fluorescent imaging potentially helps locate PGs and thus prevent inadvertent parathyroidectomy or damaging them (48). Moreover, ICG angiography may provide quantitative evaluation of in situ PG perfusion after total thyroidectomy, and could be a good predictor for postoperative hypoparathyroidism (46,47,50,51).…”

Section: Assessing Viability Of In Situ Pgsmentioning

confidence: 99%

To identify or not to identify parathyroid glands during total thyroidectomy

Chang

Lang

2017

Gland Surg.

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Hypoparathyroidism is one of the most common complications after total thyroidectomy and may impose a significant burden to both the patient and clinician. The extent of thyroid resection, surgical techniques, concomitant central neck dissection, parathyroid gland (PG) autotransplantation and inadvertent parathyroidectomy have long been some of the risk factors for postoperative hypoparathyroidism. Although routine identification of PGs has traditionally been advocated by surgeons, recent evidence has suggested that perhaps identifying fewer number of in situ PGs during surgery (i.e., selective identification) may further lower the risk of hypoparathyroidism. One explanation is that visual identification may often lead to subtle damages to the nearby blood supply of the in situ PGs and that may increase the risk of hypoparathyroidism.However, it is worth highlighting the current literature supporting either approach (i.e., routine vs. selective) remains scarce and because of the significant differences in study design, inclusions, definitions and management protocol between studies, a pooled analysis on this important but controversial topic remains an impossible task. Furthermore, it is worth nothing that identification of PGs does not equal safe preservation, as some studies demonstrated that it is not the number of PGs identified, but the number of PG preserved in situ that matters. Therefore a non-invasive, objective and reliable way to localize PGs and assess their viability intra-operatively is warranted. In this aspect, modern technology such as the indocyanine green (ICG) as near-infrared fluorescent dye for real-time in situ PG perfusion monitoring may have a potential role in the future.

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“…Many techniques and approaches have been proposed to improve the outcomes and prevent post-thyroidectomy hypocalcemia (18,20,22,(35)(36)(37)(38)(39)(40). Among these techniques, intraoperative ICG with fluorescence imaging has been one of the most promising methods for identifying and preserving parathyroid function (18,20,22).…”

Section: Syndromes Of Hypoparathyroidism After Total Thyroidectomymentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Jitpratoom

Anuwong

2017

Gland Surg.

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Intraoperative localization of the parathyroid glands with indocyanine green and Firefly(R) technology during BABA robotic thyroidectomy

Abstract: ICG with NIR light may feasibly and safely identify the parathyroid glands in BABA robotic thyroidectomy.

Cited by 76 publications

References 22 publications

Early Experience and the Feasibility of the Firefly Technology for Central Lymph Node Dissection (CLND) in Robotic Thyroidectomy Using the BABA

Early Experience and the Feasibility of the Firefly Technology for Central Lymph Node Dissection (CLND) in Robotic Thyroidectomy Using the BABA

To identify or not to identify parathyroid glands during total thyroidectomy

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

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