Comparing intraoperative parathyroid identification based on surgeon experience versus near infrared autofluorescence detection – A surgeon-blinded multi-centric study

Thomas, Giju; Solórzano, Carmen C.; Baregamian, Naira; Mannoh, Emmanuel A.; Gautam, Rekha; Irlmeier, Rebecca; Ye, Fei; Nelson, Jeremy; Long, Samuel E.; Gauger, Paul G.; Magner, Alexa; Metcalf, Tyler; Shirley, Lawrence A.; Phay, John E.; Mahadevan‐Jansen, Anita

doi:10.1016/j.amjsurg.2021.05.001

Cited by 21 publications

(32 citation statements)

References 20 publications

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“…In summary, alongside with authoritative reviews confirming the feasibility and efficacy of recent parathyroid identification aids [56][57][58], there are others that urge caution in adopting them too enthusiastically before larger prospective and randomised studies confirm their superiority over surgeon volume and skill [59,60]. For example, the analysis of our case history, while showing values for temporary hypoparathyroidism that are in line with the literature (19.29%), confirms the negligible values of our previous investigations [4,8,18,61,62], for permanent hypoparathyroidism.…”

Section: Discussionsupporting

confidence: 87%

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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Section: Discussionsupporting

confidence: 87%

Thyroidectomy for Cancer: The Surgeon and the Parathyroid Glands Sparing

Perigli

Cianchi

Giudici

et al. 2021

JCM

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“…In a previously published article, Thomas et al reported that thyroid, brown fat, and other tissues showed autofluorescence. They reported a false‐positive rate of 8.1% out of the 386 PGs examined 14 . However, in our study of four patients, we found that the surrounding tissues did not exhibit autofluorescence in NIR light, as shown in Figure 2.…”

Section: Discussionmentioning

confidence: 39%

“…However, surgeons cannot evaluate the viability of PGs intraoperatively because autofluorescence signals are emitted by both viable and nonviable PGs. Moreover, presence of metastatic lymph nodes, brown fat, and thyroid tissue may lead to false‐positive results 13–15 …”

Section: Introductionmentioning

confidence: 99%

A pilot feasibility study to assess vascularity and perfusion of parathyroid glands using a portable hand‐held imager

Lee

Kim

et al. 2021

Lasers Surg Med

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Objectives Intraoperative localization and preservation of parathyroid glands (PGs) are challenging during thyroid surgery. A new noninvasive technique of combined near‐infrared PG autofluorescence detection and dye‐free imaging angiography that allows intraoperative feedback has recently been introduced. The objective of this study was to evaluate this technique in real‐time. Materials and Methods A pilot feasibility study of a portable imaging device in four patients who underwent either thyroid lobectomy or total thyroidectomy is presented. PG autofluorescence and vascularity/tissue perfusion were monitored using a real‐time screen display during the surgical procedure. Results Three lobectomies and one total thyroidectomy were performed. Among the nine PGs identified by the operating surgeon, eight PGs were confirmed using the autofluorescence device. Each PG was successfully determined to be either well‐perfused or devascularized, and devascularized PGs were autotransplanted. Conclusions The preliminary results suggest that the combination of PG autofluorescence detection and dye‐free angiography can potentially be used to assess PG function. With further validation studies, the effectiveness of this technique in clinical practice can be further delineated.

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“…An overview of the variety of study designs within the articles can be found in Figure 3, which will be discussed in each of the paragraphs separately. [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38], 17 studies analyzed open (total or partial) thyroid dissections alone [9,12,[39][40][41][42][43][44][45][46][47][48][49][50][51][52][53], and 2 studies described endoscopic procedures on parathyroid glands or thyroid [54,55] (Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…Only a few studies used pathological validation, mostly those that included parathyroidectomies [20,21,23,24,28,29,37]. However, in the study conducted by Liu et al (2020), each suspicious parathyroid gland was biopsied and submitted for a frozen section analysis, after which the remaining part of the parathyroid gland was left in situ.…”

Section: Methodsmentioning

confidence: 99%

Heterogeneity in Utilization of Optical Imaging Guided Surgery for Identifying or Preserving the Parathyroid Glands—A Meta-Narrative Review

Feitsma

Schouw

Noltes

et al. 2022

Life

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Background: Postoperative hypoparathyroidism is the most common complication after total thyroidectomy. Over the past years, optical imaging techniques, such as parathyroid autofluorescence, indocyanine green (ICG) angiography, and laser speckle contrast imaging (LSCI) have been employed to save parathyroid glands during thyroid surgery. This study provides an overview of the utilized methods of the optical imaging techniques during total thyroidectomy for parathyroid gland identification and preservation. Methods: PUBMED, EMBASE and Web of Science were searched for studies written in the English language utilizing parathyroid autofluorescence, ICG-angiography, or LSCI during total thyroidectomy to support parathyroid gland identification or preservation. Case reports, reviews, meta-analyses, animal studies, and post-mortem studies were excluded after the title and abstract screening. The data of the studies were analyzed qualitatively, with a focus on the methodologies employed. Results: In total, 59 articles were included with a total of 6190 patients. Overall, 38 studies reported using parathyroid autofluorescence, 24 using ICG-angiography, and 2 using LSCI. The heterogeneity between the utilized methodology in the studies was large, and in particular, regarding study protocols, imaging techniques, and the standardization of the imaging protocol. Conclusion: The diverse application of optical imaging techniques and a lack of standardization and quantification leads to heterogeneous conclusions regarding their clinical value. Worldwide consensus on imaging protocols is needed to establish the clinical utility of these techniques for parathyroid gland identification and preservation.

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Comparing intraoperative parathyroid identification based on surgeon experience versus near infrared autofluorescence detection – A surgeon-blinded multi-centric study

Cited by 21 publications

References 20 publications

Thyroidectomy for Cancer: The Surgeon and the Parathyroid Glands Sparing

Thyroidectomy for Cancer: The Surgeon and the Parathyroid Glands Sparing

A pilot feasibility study to assess vascularity and perfusion of parathyroid glands using a portable hand‐held imager

Heterogeneity in Utilization of Optical Imaging Guided Surgery for Identifying or Preserving the Parathyroid Glands—A Meta-Narrative Review

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