Application of Nano-Carbon in Lymph Node Dissection for Thyroid Cancer and Protection of Parathyroid Glands

Tian, Wuguo; Jiang, Yan; Gao, Bo; Zhang, Xiaohua; Zhang, Shu; Zhao, Jing; He, Yonghong; Luo, Dong-Hua

doi:10.12659/msm.890721

Cited by 30 publications

(4 citation statements)

References 10 publications

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“…Hypocalcemia occurred in 5 patients of the control group (20%) and 4 patients of the test group (4%) at 1 day after surgery. No between-group significant difference was found in hypocalcemia at 1st day, which was different from the results of hypocalcemia at 48 hours after surgery reported by Luo [16]. This was because every patient immediately got calcium supplementation after total thyroidectomy, which affected the calcium serum level at 1 day after surgery.…”

Section: Discussioncontrasting

confidence: 81%

Identification of the Parathyroid Gland with Vasculature by Intraoperative Carbon Nanoparticles

Yin¹,

Bi²,

Wang³

2021

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Background: We aimed to investigate the ability of carbon nanoparticles to identify parathyroid glands with vasculature during thyroid surgery. Material and methods: Totally 42 patients with various thyroid diseases were selected for the prospective research of carbon nanoparticle injection used in thyroidectomy. Another 42 patients without receiving carbon nanoparticle injection were selected as the control group. All cases underwent total or subtotal bilateral thyroidectomy. Before the ligation of the superior and inferior poles of the thyriod lobes, 0.1 mL of a carbon nanoparticle suspension was injected into the two poles. Important tissues such as the recurrent laryngeal nerve, parathyroid gland with blood supply and the inferior thyroid artery were identified and protected. Results: The parathyroid glands with vasculature were not stained and thus remained the primary color in all cases, while abnormal thyroid tissues were stained black. After 5 minutes, thyroid lobes were injected with the carbon nanoparticle suspension and the original color of parathyroid glands was unchanged. Even the parathyroids with blood supply can be identified and protected. The number of parathyroid glands for autotransplantation was one in the test group and six in the control group. At one day after the thyroid surgery, hypocalcemia became detectable in four patients of the test group and in five of the control group. Twenty-four instances of hypoparathyroidism occurred at 1 day after surgery in the control group, while ten instances in the test group. Conclusion: Intraoperatvie carbon nanoparticle suspension injection is an effective and safe technique for guiding thyroid surgery. The carbon nanoparticle suspension plays an important role in identifying the vasculatural parathyroid glands, while protecting the physiologic function of the parathyroid glands during surgery.

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Section: Discussioncontrasting

confidence: 81%

Identification of the Parathyroid Gland with Vasculature by Intraoperative Carbon Nanoparticles

Yin¹,

Bi²,

Wang³

2021

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“… 39 The removal of lymph and adipose tissue may cause avascular necrosis of the parathyroid glands, which may result in hypocalcaemia in patients with TT after surgery. 40 Studies have indicated that the incidence of transient hypocalcaemia after TT is 27.5%. 41 A previous study reported that the incidence of hypocalcaemia in patients undergoing TT (38.8%) was significantly higher than that in patients undergoing lobectomy (13.8%).…”

Section: Discussionmentioning

confidence: 99%

Risk factors for postoperative hypocalcaemia after thyroidectomy: A systematic review and meta-analysis

Chen

Zhao

et al. 2021

J Int Med Res

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Objective A meta-analysis to investigate the risk factors for postoperative hypocalcaemia after thyroidectomy in adult patients. Methods A systematic search of publications in the electronic databases (PubMed®, The Cochrane Library, Web of Science, OVID and Embase®) from inception to June 2020 was conducted. Screening of titles, abstracts and full texts and data extraction were independently performed by two authors. The OR was selected as the pooled estimate. Results The analysis included 23 studies. Twelve significant risk factors for postoperative hypocalcaemia were identified: hypoparathyroidism, OR 5.58; total thyroidectomy, OR 3.59; hypomagnesaemia, OR 2.85; preoperative vitamin D deficiency, OR 2.32; female sex, OR 1.49; thyroid malignancy, OR 1.85; thyroiditis, OR 1.48; substernal multinodular goitres, OR 1.70; parathyroidectomy, OR 1.58; central compartment neck dissection, OR 1.17; modified radical neck dissection, OR 1.57; and central neck dissection, OR 1.54. Conclusions This meta-analysis provides moderate-to-high quality evidence that the 12 risk factors were predictive of postoperative hypocalcaemia, which should be monitored closely before thyroidectomy.

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“…In most of the included studies, the dose of CNs is 0.1 to 0.2 ml per point and 2–3 points around tumor within the thyroid capsule were recommended. After being properly injected, the CNs enter the lymphatic capillaries and stain lymph nodes in 10-15min, rather than PGs and the recurrent laryngeal nerve [ 10 , 13 , 18 – 20 , 27 , 32 – 37 ]. It is hypothesized that this technique facilitates intraoperative identification of LNs and improves thoroughness of LN dissection for thyroid carcinoma.…”

Section: Discussionmentioning

confidence: 99%

The role of carbon nanoparticle in lymph node detection and parathyroid gland protection during thyroidectomy for non-anaplastic thyroid carcinoma- a meta-analysis

et al. 2020

PLoS ONE

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Objective To assess the efficiency of the carbon nanoparticles (CNs) in lymph node identification and parathyroid gland (PG) protection during thyroidectomy for non-anaplastic thyroid carcinoma (N-ATC). Methods A systematic literature search for relevant literatures published up to December 2018 in PubMed, EMBASE, Web of Science and Cochrane Library was performed. Both English and Chinese literatures were retrieved and analyzed. Randomized controlled trials or nonrandomized controlled trials comparing the use of CNs with the use of methylene blue or a blank control in patients undergoing thyroidectomy for N-ATC were enrolled in this study. The primary outcomes included the number of lymph nodes harvested, the rate of lymph nodes involved, and the rates of accidental parathyroidectomy, hypoparathyroidism, and hypocalcemia. Weighted mean differences (WMDs), odds ratios (ORs) and risk differences (RDs) were calculated for the dichotomous outcome variables. Between study heterogeneity was tested using the Q tests and the I2 statistics. All analyses were performed using Review Manager (version 5.3.5). Results 25 studies comprising 3266 patients were included in this analysis. The total number of lymph nodes harvested in the CNs groups was significantly higher than that in the control groups (WMD, 2.36; 95% CI, 1.40 to 3.32; P <0.01). Administrating CNs was associated with a lower incidence of accidental PG removal (OR = 0.28, 95% CI = 0.21 to 0.37, P<0.01) and lower rates of both postoperative transient hypoparathyroidism (OR = 0.46, 95% CI = 0.33 to 0.64, P <0.01) and transient hypocalcemia (OR = 0.46, 95% CI = 0.33 to 0.65, P <0.01). No significant difference was found concerning lymph node metastatic rates between CNs group and control group. Subgroup analysis indicated that the application of CNs in reoperation thyroidectomy reduced both the rate of transient hypoparathyroidism (OR = 0.21, 95% CI = 0.06 to 0.75, P = 0.02) and the possibility of accidental PGs removal (OR = 0.21, 95% CI = 0.07 to 0.62, P = 0.004, P<0.05). Conclusions The application of CNs in thyroidectomy for N-ATC results in higher number of lymph node harvested and better PG protection during both initial and reoperation thyroidectomy.

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Application of Nano-Carbon in Lymph Node Dissection for Thyroid Cancer and Protection of Parathyroid Glands

Cited by 30 publications

References 10 publications

Identification of the Parathyroid Gland with Vasculature by Intraoperative Carbon Nanoparticles

Identification of the Parathyroid Gland with Vasculature by Intraoperative Carbon Nanoparticles

Risk factors for postoperative hypocalcaemia after thyroidectomy: A systematic review and meta-analysis

The role of carbon nanoparticle in lymph node detection and parathyroid gland protection during thyroidectomy for non-anaplastic thyroid carcinoma- a meta-analysis

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