Intraoperative near‐infrared autofluorescence imaging for hypocalcemia risk reduction after total thyroidectomy: Evidence from a meta‐analysis

Weng, Yu-Jing; Jiang, Jiang; Liu, Min; Ai, Qing; Debiao, Chen; Chen, Wei‐Chun; Huang, Zhi-heng

doi:10.1002/hed.26733

Cited by 13 publications

(19 citation statements)

References 39 publications

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“…Benmiloud et al (18) demonstrated that the use of the autofluorescence-detecting devices was associated with an increased mean number of identified PTGs, a reduced rate of parathyroid autotransplantation, and a significantly lower rate of immediate postoperative hypocalcemia (5.2% vs. 20.9%). A meta-analysis of six eligible studies with a total of 2180 patients showed that NIRAF imaging reduces the risk of transient hypocalcemia and may lower the rate of permanent hypocalcemia (19). The prevalence of transient hypocalcemia was 8.11% (40/493) and 25.19% (425/1687) in the NIRAF and naked eye groups, respectively.…”

Section: Discussionmentioning

confidence: 99%

Preliminary experience with the EleVision IR system in detection of parathyroid glands autofluorescence and perfusion assessment with ICG

Makovac

Muradbegovic²,

Mathieson³

et al. 2022

Front. Endocrinol.

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BackgroundPostoperative hypoparathyroidism remains the most frequent complication of neck endocrine surgery. In order to reduce the incidence of this feared complication, several systems for imaging of near infrared autofluorescence (NIRAF) have been invented to help surgeons identify parathyroid glands (PTGs) and evaluate their vascularization. We evaluated the efficacy of the EleVision IR system in thyroid and parathyroid surgery.MethodsWe used the EleVision IR system in 25 patients who underwent thyroid/parathyroid surgery or both at our institution between December 2020 and July 2021. At various stages of the surgery, the surgeon first looked for PTGs with the naked eye and then completed the visual inspection with NIRAF imaging. We then compared both the naked eye and NIRAF-supported PTGs detection rates. At the end of surgery, we performed indocyanine green angiography of PTGs in 17 patients.ResultsIn total, we identified 80% of PTGs: 65% with the naked eye only and additional 15% with the assistance of the EleVision IR system. 14 of 17 patients evaluated by ICG angiography had at least one well-vascularized PTG. Only one of these patients (a case of subtotal parathyroidectomy for tertiary hyperparathyroidism) developed symptomatic postoperative hypocalcemia despite a normal parathormone level. The three other patients had at least one remaining moderately-vascularized PTG and only one patient developed transient postoperative hypoparathyroidism.ConclusionWe concluded that EleVision IR provides an efficient support for identification and evaluation of PTGs, and may be of great assistance in endocrine surgery. The images are easy to interpret even for less experienced surgeons thanks to the different types of color visualization and the possibility to measure the relative fluorescence intensity of PTGs and surrounding tissues.

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Section: Discussionmentioning

confidence: 99%

Preliminary experience with the EleVision IR system in detection of parathyroid glands autofluorescence and perfusion assessment with ICG

Makovac

Muradbegovic²,

Mathieson³

et al. 2022

Front. Endocrinol.

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“…The authors included 6 studies involving 2180 patients. The prevalence of transient hypocalcemia was 8.11% in the NIR-AF group and 25.19% in the N-E group (p < 0.0001), while the prevalence of permanent hypocalcemia was 0% in the NIR-AF group and 2.19% in the N-E group (p = 0.05) [60].…”

Section: Identification Of Parathyroid Glands With Fluorescence Systemsmentioning

confidence: 86%

“…The recommended dose for PG visualization is 0.2-0.5 mg/kg, which may be repeated as required without exceeding the maximal daily dose of 5 mg/kg [56][57][58]. Both techniques have shown promising results in several studies in the literature [46][47][48]54,59,60].…”

Section: Identification Of Parathyroid Glands With Fluorescence Systemsmentioning

confidence: 99%

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Technological Innovations in Thyroid Cancer Surgery

Cappellacci¹,

Canu²,

Piras³

et al. 2022

Oncologie

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Thyroid cancer is the fifth most common cancer in the USA, with differentiated subtype accounting for more than 95% of neoplasm. Surgery remains the mainstay of treatment, either with lobectomy or total thyroidectomy. In the last decades, many technological innovations have been introduced in this field. The aim of this review is to illustrate the most recent advances regarding the classical surgical approach, particularly regarding hemostatic devices, parathyroid identification with fluorescence systems, intraoperative identification of lymph node metastases, and intraoperative neuromonitoring.

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“…To date, unfortunately only a few studies have demonstrated a direct correlation between visualization and glandular perfusion and a reduction in hypoparathyroidism [30], which is in any case limited to the temporary but not definitive form. Moreover, none of the prevention methods adopted seem to be able to reduce hypocalcaemia [42,[49][50][51][52][53][54][55].…”

Section: Discussionmentioning

confidence: 99%

Thyroidectomy for Cancer: The Surgeon and the Parathyroid Glands Sparing

Perigli

Cianchi

Giudici

et al. 2021

JCM

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Background: The diagnosis of thyroid cancer is continuously increasing and consequently the amount of thyroidectomy. Notwithstanding the actual surgical skill, postoperative hypoparathyroidism still represents its most frequent complication. The aims of the present study are to analyze the rate of postoperative hypoparathyroidism after thyroidectomy, performed for cancer by a single first operator, without any technological aid, and to compare the data to those obtained adopting the most recent technological adjuncts developed to reduce the postoperative hypoparathyroidism. Methods: During the period 1997–2020 at the Endocrine Surgery Unit of the Department of Clinical and Experimental Medicine of the University of Florence, 1648 consecutive extracapsular thyroidectomies for cancer (401 with central compartment node dissection) were performed. The percentage of hypoparathyroidism, temporary or permanent, was recorded both in the first period (Group A) and in the second, most recent period (Group B). Total thyroidectomies were compared either with those with central compartment dissection and lobectomies. Minimally invasive procedures (MIT, MIVAT, some transoral) were also compared with conventional. Fisher’s exact and Chi-square tests were used for comparison of categorical variables. p < 0.01 was considered statistically significant. Furthermore, a literature research from PubMed® has been performed, considering the most available tools to better identify parathyroid glands during thyroidectomy, in order to reduce the postoperative hypoparathyroidism. We grouped and analyzed them by technological affinity. Results: On the 1648 thyroidectomies enrolled for the study, the histotype was differentiated in 93.93 % of cases, medullary in 4% and poorly differentiated in the remaining 2.06%. Total extracapsular thyroidectomy and lobectomy were performed respectively in 95.45% and 4.55%. We recorded a total of 318 (19.29%) cases of hypocalcemia, with permanent hypoparathyroidism in 11 (0.66%). In regard to the literature, four categories of tools to facilitate the identification of the parathyroids were identified: (a) vital dye; (b) optical devices; (c) autofluorescence of parathyroids; and (d) autofluorescence enhanced by contrast media. Postoperative hypoparathyroidism had a variable range in the different groups. Conclusions: Our data confirm that the incidence of post-surgical hypoparathyroidism is extremely low in the high volume centers. Its potential reduction adopting technological adjuncts is difficult to estimate, and their cost, together with complexity of application, do not allow immediate routine use. The trend towards increasingly unilateral surgery in thyroid carcinoma, as confirmed by our results in case of lobectomy, is expected to really contribute to a further reduction of postsurgical hypoparathyroidism.

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Intraoperative near‐infrared autofluorescence imaging for hypocalcemia risk reduction after total thyroidectomy: Evidence from a meta‐analysis

Cited by 13 publications

References 39 publications

Preliminary experience with the EleVision IR system in detection of parathyroid glands autofluorescence and perfusion assessment with ICG

Preliminary experience with the EleVision IR system in detection of parathyroid glands autofluorescence and perfusion assessment with ICG

Technological Innovations in Thyroid Cancer Surgery

Thyroidectomy for Cancer: The Surgeon and the Parathyroid Glands Sparing

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