The utility of indocyanine green (ICG) for the identification and assessment of viability of the parathyroid glands during thyroidectomy

Priyanka, S; Sam, Shawn Thomas; Rebekah, Grace; Sen, Supriya; Thomas, Varghese; Wankhar, Syrpailyne; Cherian, Anish Jacob; Abraham, Deepak Thomas; Paul, Mazuvanchary Jacob

doi:10.1007/s13304-021-01202-4

Cited by 6 publications

(6 citation statements)

References 41 publications

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“…If there was an increase of more than 25% in the FI, we assumed that the vascularity of the gland was preserved and kept it. This technique provided us with an objective measurement and allowed us to eliminate the impact of surgeon experience and subjective evaluation like other studies in the literature [ 16 , 19 ]. In addition, measuring the change in FI after a second ICG injection instead of total FI can help to overcome a challenge of ICGA, which is the persistence of fluorescence within the parathyroid gland due to prior injection complicating the evaluation of current perfusion.…”

Section: Discussionmentioning

confidence: 99%

Impact of Indocyanine Green Angiography on Postoperative Parathyroid Function: A Propensity Score Matching Study

Karahan,

Toprak,

Celik

et al. 2024

JCM

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Background: Thyroidectomy constitutes an important portion of endocrine surgery procedures and is associated with various complications such as bleeding, recurrent laryngeal nerve injury, and postoperative hypoparathyroidsm. Effective parathyroid preservation during thyroid surgery is crucial for patient well-being, with current strategies heavily reliant on surgeon experience. Among various methods, Indocyanine Green Angiography (ICGA) offers a promising method for intraoperative assessment of parathyroid gland perfusion. Methods: In a retrospective study, patients undergoing bilateral thyroidectomy from January 2021 to January 2023 were analyzed, excluding those with previous thyroidectomy, parathyroid disease, or chronic kidney disease. The study compared a control group (n = 175) with an ICGA group (n = 120), using propensity score matching for statistical analysis. Matched cohorts included 120 patients in each group. The primary outcome of this study was identified as temporary postoperative hypoparathyroidism, with secondary outcomes including the rate of parathyroid reimplantation and the incidence of permanent postoperative hypoparathyroidism. Results: The ICGA group showed significantly more parathyroid autotransplantations (p < 0.01). While not statistically significant, the control group had a higher incidence of temporary postoperative hypoparathyroidism (p < 0.09). Rates of hypocalcemia on postoperative day 1 and permanent hypocalcemia were similar. Subgroup analysis indicated more postoperative day 1 hypoparathyroidism in the control group during central neck dissections (p < 0.049). Conclusions: Intraoperative ICGA use correlated with higher parathyroid autotransplantation and suggested reduced postoperative hypoparathyroidism. Changes in fluorescence intensity following a second ICG injection may provide an objective method to assess parathyroid perfusion. Further large-scale studies are needed to fully understand ICGA’s impact on parathyroid preservation.

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Section: Discussionmentioning

confidence: 99%

Impact of Indocyanine Green Angiography on Postoperative Parathyroid Function: A Propensity Score Matching Study

Karahan,

Toprak,

Celik

et al. 2024

JCM

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“…Excessive dosage may lead to a too-bright background and affect the observation of PGs. In addition, the standard for evaluation of parathyroid imaging is diverse in different studies ( 12 , 137 , 138 ). After ICG injection, there is no unified evaluation scheme for parathyroid perfusion that can guide clinical application.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, the research suggests that the imaging method is of limited use in patients undergoing first-time neck surgery because of the impact of thyroid fluorescence. Another scoring criterion is based on the fluorescence brightness of the PGs compared to the fluorescence brightness of the surrounding tissues ( 137 ). The fluorescence intensity score includes a 1–3 grading scale, which means no visible fluorescence, fluorescence exists but no more than the surrounding tissues, and parathyroid is more fluorescent than the surrounding tissues.…”

Section: Icg-nir Fluorescence Imagingmentioning

confidence: 99%

The magic mirror: a novel intraoperative monitoring method for parathyroid glands

et al. 2023

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The accurate detection of parathyroid glands (PGs) during surgery is of great significance in thyroidectomy and parathyroidectomy, which protects the function of normal PGs to prevent postoperative hypoparathyroidism and the thorough removal of parathyroid lesions. Existing conventional imaging techniques have certain limitations in the real-time exploration of PGs. In recent years, a new, real-time, and non-invasive imaging system known as the near-infrared autofluorescence (NIRAF) imaging system has been developed to detect PGs. Several studies have confirmed that this system has a high parathyroid recognition rate and can reduce the occurrence of transient hypoparathyroidism after surgery. The NIRAF imaging system, like a magic mirror, can monitor the PGs during surgery in real time, thus providing great support for surgeries. In addition, the NIRAF imaging system can evaluate the blood supply of PGs by utilizing indocyanine green (ICG) to guide surgical strategies. The NIRAF imaging system and ICG complement each other to protect normal parathyroid function and reduce postoperative complications. This article reviews the effectiveness of the NIRAF imaging system in thyroidectomies and parathyroidectomies and briefly discusses some existing problems and prospects for the future.

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“…Суть первого метода заключается в введении ICG внутривенно с последующей оценкой ангиограммы, второго -в визуальной оценке интенсивной флуоресценции паращитовидных желез. Среди 50 прооперированных пациентов в объеме тиреоидэктомии, в 73 % случаев при помощи описанных выше методов были визуализированы околощитовидные железы [26].…”

Section: злокачественные опухолиunclassified

Preventive central neck lymph node dissection as a stage in the treatment of papillary thyroid cancer

Tigrov,

Yakovleva,

Kropotov

et al. 2024

Malignant Tumours

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Relevance: The need of prophylactic cervical lymph node dissection for the detection of low grade thyroid cancer remains debatable since preoperative examination does not always allow determining the involvement of a group VI regional lymph collector.Objective: to evaluate the frequency of group VI nodes involvement with clinical N0–Nx based on the results of a morphological examination after performing a preventive central neck lymph node dissection.Materials and methods: the study included 295 patients who underwent surgery from 2016 to 2022 for papillary thyroid cancer with cT1–T2, N0–Nx. There were 11.5 % of men included (n = 34) and 88.5 % of women (n = 261). Of these, 40.7 % (n = 120) were less than 55 years old. All patients underwent surgical treatment which included thyroidectomy or hemithyroidectomy with cervical lymph node dissection.Results: The study included 295 patients with cT1 — 247 (83.7 %) and cT2 — 48 (16.3 %). Pathomorphological examination changed the T index in some patients: pT1 was found in 80.3 % of cases (n = 237); рТ2 — in 9.2 % (n = 27); рТ3 — in 10.5 % (n = 31). Central neck lymph nodes involvement was detected in 77 (26.1 %) out of 295 patients. There was a correlation between the frequency of metastases detection and the size of the primary tumor: 22.8 % (n = 54) of metastases with pT1, 33.3 % (n = 9) with pT2, and 45.2 % (n = 14) with pT3. Transient hypocalcemia was found in 32 % of patients with pT1, 69 % with pT2, and 84 % with pT3. Two patients had unilateral transient paresis of the larynx.Conclusions: Our analysis demonstrates that the preventive central neck lymph node dissection in patients with low grade thyroid cancer is an important component of surgical treatment, which allows to improve the treatment results with a possible subsequent reduction in the risk of distant progression. In this study 77 (26.1 %) of 295 patients had metastases in the lymph nodes of the central neck. The number of postoperative complications affecting the quality of life of patients was acceptable with 0.67 % of paresis of the larynx and 39 % of mild hypocalcemia.

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The utility of indocyanine green (ICG) for the identification and assessment of viability of the parathyroid glands during thyroidectomy

Cited by 6 publications

References 41 publications

Impact of Indocyanine Green Angiography on Postoperative Parathyroid Function: A Propensity Score Matching Study

Impact of Indocyanine Green Angiography on Postoperative Parathyroid Function: A Propensity Score Matching Study

The magic mirror: a novel intraoperative monitoring method for parathyroid glands

Preventive central neck lymph node dissection as a stage in the treatment of papillary thyroid cancer

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