Parathyroid gland angiography with indocyanine green fluorescence to predict parathyroid function after thyroid surgery

Abstract

BackgroundPostoperative hypoparathyroidism remains the most common complication following thyroidectomy. The aim of this pilot study was to evaluate the use of intraoperative parathyroid gland angiography in predicting normal parathyroid gland function after thyroid surgery.MethodsAngiography with the fluorescent dye indocyanine green (ICG) was performed in patients undergoing total thyroidectomy, to visualize vascularization of identified parathyroid glands.ResultsSome 36 patients underwent ICG angiography during thyroidectomy. All patients received standard calcium and vitamin D supplementation. At least one well vascularized parathyroid gland was demonstrated by ICG angiography in 30 patients. All 30 patients had parathyroid hormone (PTH) levels in the normal range on postoperative day (POD) 1 and 10, and only one patient exhibited asymptomatic hypocalcaemia on POD 1. Mean(s.d.) PTH and calcium levels in these patients were 3·3(1·4) pmol/l and 2·27(0·10) mmol/l respectively on POD 1, and 4·0(1.6) pmol/l and 2·32(0·08) mmol/l on POD 10. Two of the six patients in whom no well vascularized parathyroid gland could be demonstrated developed transient hypoparathyroidism. None of the 36 patients presented symptomatic hypocalcaemia, and none received treatment for hypoparathyroidism.Conclusion PTH levels on POD 1 were normal in all patients who had at least one well vascularized parathyroid gland demonstrated during surgery by ICG angiography, and none required treatment for hypoparathyroidism.

Transoral endoscopic thyroidectomy using vestibular approach: updates and evidences

“…The use of indocyaninegreen (ICG) is being investigated in terms of its use for locating the parathyroid glands or proofing of the viable glands (42)(43)(44). This could be applied to TOETVA for reducing the rate of hypoparathyroidism.…”

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

“…In our preliminary study, 71 of 101 PGs were visually evaluated as wellvascularized, while only 51 were considered wellvascularized on ICG angiography (45). Thus, the perfusion status (and therefore the functional ability to produce PTH) was visually over-evaluated in 20 of 71 PGs (28.2%).…”

Use of fluorescent angiography with indocyanine green for prediction of hypocalcemia development after thyroidectomy

“…Дан-ная методика зарекомендовала себя в сердечно-сосу-дистой хирургии, где она применяется для оценки проходимости шунтов коронарных артерий [7], в ре-конструктивной хирургии молочной железы для оцен-ки перфузии кожных лоскутов [8,9]. В хирургии щи-товидной железы продемонстрирована возможность интраоперационной детекции паращитовидных желез и оценки их кровоснабжения с помощью данной ме-тодики [10,11]. Нами проведено пилотное исследова-ние по применению индоцианина зеленого для оценки васкуляризации паращитовидных желез после тирео-идэктомии.…”