Rapid intraoperative perfusion assessment of parathyroid adenomas with ICG using a wide-field portable hand-held fluorescence imaging system

Matson, Jared; Lwin, Thinzar M.; Bouvet, Michael

doi:10.1016/j.amjsurg.2021.07.027

Cited by 8 publications

(6 citation statements)

References 36 publications

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“…[41] Whereas, for identi cation of parathyroid adenomas, ICG is administered intra-operatively 1-2 minutes before supposed signal detection. [27] Matson et al demonstrated that, relying on the underlying mechanism of vascular ush and retention induced by enhanced permeability of the vessels, ICG exhibited rapid in ow and accumulation in adenomas, resulting in the detection of ICG-signal within minutes after administration. [27] Our observations are consistent with previous research ndings, revealing that ICG demonstrated a comparable uorescence in ow and retention pattern in paragangliomas.…”

Section: Discussionmentioning

confidence: 99%

Fluorescence-Guided Minimally-Invasive Resection of Abdominal Paragangliomas using Indocyanine Green

Dam,

Crobach,

Boekestijn

et al. 2024

Preprint

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This study explores the utility of near-infrared (NIR) fluorescence imaging with indocyanine green (ICG) in enhancing the intraoperative identification and guidance for the resection of abdominal paragangliomas, rare neuroendocrine tumors often challenging to detect during surgery. Due to their anatomical location, often small size, and the similar appearance of the lesions in regard to their surrounding tissue. Minimally-invasive resections were planned for patients with suspected abdominal paragangliomas, who received a single bolus of 5mg ICG after abdominal exploration. NIR fluorescence imaging of the suspected abdominal region of the suspected lesion immediately followed administration, assessing fluorescence signals, intraoperative identification, and correlation with histopathology. Among five suspect lesions resected, four were imaged with NIR fluorescence, with pathology confirming four as paragangliomas and one as an adrenal adenoma. NIR fluorescence identified all four lesions, surpassing the limitations of white-light visualization. Homogeneous fluorescence signals appeared 30-60 seconds post-ICG, enduring up to 30 minutes. The study demonstrates the feasibility and potential clinical value of fluorescence-guided minimally-invasive resections of abdominal paragangliomas using a single intravenous ICG dose. These findings support the scientific basis for routine use of ICG-fluorescence-guided surgery in challenging anatomical cases, providing valuable assistance in lesion detection and resection.

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Section: Discussionmentioning

confidence: 99%

Fluorescence-Guided Minimally-Invasive Resection of Abdominal Paragangliomas using Indocyanine Green

Dam,

Crobach,

Boekestijn

et al. 2024

Preprint

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“…This is due to its underlying mechanism involving hepatic metabolism of ICG and its subsequent accumulation within hepatocellular carcinomas or the surrounding hepatic parenchyma of liver metastases, due to an impaired parenchymal metabolic function 46 . Whereas, for identification of parathyroid adenomas, ICG is administered intra-operatively 1–2 min before supposed signal detection 32 . Matson et al .…”

Section: Discussionmentioning

confidence: 99%

Fluorescence-guided minimally-invasive resection of abdominal paragangliomas using indocyanine green

van Dam,

Crobach,

Boekestijn

et al. 2024

Sci Rep

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This retrospective study explores the utility of near-infrared (NIR) fluorescence imaging with indocyanine green (ICG) in enhancing the intraoperative identification and guidance for the resection of abdominal paragangliomas. They can be challenging to detect during minimally invasive surgery, due to their anatomical location, varying size and similar appearance in regard to their surrounding tissue. Patients with suspected abdominal paragangliomas planned for a minimally-invasive resection were included. As part of standard of care they received single intravenous dose of 5 mg ICG after abdominal exploration. NIR fluorescence imaging of the anatomical region of the suspected lesion was performed immediately following intravenous administration, to assess fluorescence signals, intraoperative identification, and histopathological correlation. Out of five resected suspicious lesions, four were imaged with NIR fluorescence, pathology confirming four as paragangliomas, the latter turned out to be an adrenal adenoma. NIR fluorescence identified all four lesions, surpassing the limitations of white-light visualization. Homogeneous fluorescence signals appeared 30–60 s post-ICG administration, which lasted up to 30 min. The study demonstrates the feasibility and potential clinical value of fluorescence-guided minimally-invasive resections of abdominal paragangliomas using a single intravenous ICG dose. These findings support the scientific basis for routine use of ICG-fluorescence-guided surgery in challenging anatomical cases, providing valuable assistance in lesion detection and resection.

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“…Zaidi et al further demonstrated the utility of ICG fluorescence imaging specifically for patients undergoing initial surgery for primary hyperparathyroidism, demonstrating that 92.9% of glands visible to the naked eye demonstrated ICG uptake and that all 33 patients in the study had been biochemically cured of their hyperparathyroidism after parathyroidectomy ( 10 ). Given that ICG fluorescence imaging is a safe and adaptable modality for multiple procedures, groups have refined the technique with more standardized protocols for use, including guidelines for optimal administration dosing and timing ( 20 ). The power of ICG fluorescence-guided parathyroidectomy was importantly demonstrated by DeLong et al when 18 of 54 patients in the study had adenomas which failed to localize on pre-operative Sestamibi scan.…”

Section: Discussionmentioning

confidence: 99%

Indocyanine green fluorescence guided resection of parathyroid adenoma of the carotid sheath: a case report and review of the literature

Rupp¹,

Barba²,

Goldhaber³

et al. 2023

Gland Surg

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Background: Ectopic parathyroid tissue can pose difficulties in diagnosis, management, and resection of adenomas in patients with hyperparathyroidism. The use of multimodal pre-operative imaging is recommended due to the diverse anatomic presentation of parathyroid adenomas and the potential presence of multiple adenomas. Resection failure still can occur, however, indocyanine green (ICG) fluorescence imaging is an intraoperative tool that has potential to help address this challenge. In the case which follows we demonstrate the use of ICG fluorescence imaging to assist in successful resection of a parathyroid adenoma located within the carotid sheath.Case Description: We present the case of a 75-year-old woman with primary hyperparathyroidism due to a parathyroid adenoma localized to the left carotid sheath, posterior to the carotid artery. Careful resection was aided by ICG fluorescence guidance allowing for complete resection and immediate postoperative restoration of normal Parathyroid Hormone and calcium levels. The patient had no peri-operative complications and had an unremarkable post-operative course. Conclusions:The anatomical heterogeneity of parathyroid gland adenomas within and around the carotid sheath presents a unique diagnostic and surgical scenario; however, the use of intra-operative ICG, as presented in this case, has important implications for endocrine surgeons and surgical trainees alike. This tool provides improved intra-operative identification of the parathyroid tissue allowing for safe resection, especially in cases involving critical anatomical structures.

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Rapid intraoperative perfusion assessment of parathyroid adenomas with ICG using a wide-field portable hand-held fluorescence imaging system

Cited by 8 publications

References 36 publications

Fluorescence-Guided Minimally-Invasive Resection of Abdominal Paragangliomas using Indocyanine Green

Fluorescence-Guided Minimally-Invasive Resection of Abdominal Paragangliomas using Indocyanine Green

Fluorescence-guided minimally-invasive resection of abdominal paragangliomas using indocyanine green

Indocyanine green fluorescence guided resection of parathyroid adenoma of the carotid sheath: a case report and review of the literature

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