Subtotal Parathyroidectomy Under Indocyanine Green Angiography

FortunyJordi, Vidal; GuigardSébastien,; DiaperJohn,; KarenovicsWolfram,; TriponezFrédéric,

doi:10.1089/ve.2015.0056

Cited by 13 publications

(8 citation statements)

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“…Another limitation is the subjective nature of visual and ICG scores. Fluorescence was not quantifiable with the fluorescence equipment used; instead, shades of grey of the parathyroid gland were compared visually with those of the surrounding vessels and tissues. Unfortunately, the Novadaq camera system used in this study does not give a quantitative/numerical score but a qualitative one, in colour shades.…”

Section: Discussionmentioning

confidence: 99%

Randomized clinical trial of intraoperative parathyroid gland angiography with indocyanine green fluorescence predicting parathyroid function after thyroid surgery

Fortuny

Sadowski

Belfontali

et al. 2018

British Journal of Surgery

160

150

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BackgroundHypoparathyroidism, the most common complication after thyroid surgery, leads to hypocalcaemia and significant medical problems. An RCT was undertaken to determine whether intraoperative parathyroid gland angiography with indocyanine green (ICG) could predict postoperative hypoparathyroidism, and obviate the need for systematic blood tests and oral calcium supplementation.MethodsBetween September 2014 and February 2016, patients who had at least one well perfused parathyroid gland on ICG angiography were randomized to receive standard follow‐up (measurement of calcium and parathyroid hormone (PTH) on postoperative day (POD) 1 and systematic supplementation with calcium and vitamin D; control group) or no supplementation and no blood test on POD 1 (intervention group). In all patients, calcium and PTH levels were measured 10–15 days after thyroidectomy. The primary endpoint was hypocalcaemia on POD 10–15.ResultsA total of 196 patients underwent ICG angiography during thyroid surgery, of whom 146 had at least one well perfused parathyroid gland on ICG angiography and were randomized. None of these patients presented with hypoparathyroidism, including those who did not receive calcium supplementation. The intervention group was statistically non‐inferior to the control group (exact 95 per cent c.i. of the difference in proportion of patients with hypocalcaemia –0·053 to 0·053; P = 0·012). Eleven of the 50 excluded patients, in whom no well perfused parathyroid gland could be identified by angiography, presented with hypoparathyroidism on POD 1, and six on POD 10–15, which was significantly different from the findings in randomized patients (P = 0·007).ConclusionICG angiography reliably predicts the vascularization of the parathyroid glands and obviates the need for postoperative measurement of calcium and PTH, and supplementation with calcium in patients with at least one well perfused parathyroid gland. Registration number: NCT02249780 (http://www.clinicaltrials.gov).

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Section: Discussionmentioning

confidence: 99%

Randomized clinical trial of intraoperative parathyroid gland angiography with indocyanine green fluorescence predicting parathyroid function after thyroid surgery

Fortuny

Sadowski

Belfontali

et al. 2018

British Journal of Surgery

160

150

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“…Near-infrared light can detect parathyroid tissue with a sensitivity of 83% to 92% and is gaining popularity as a useful surgical adjunct for intraoperative identification of parathyroid tissue. [388][389][390][391]…”

Section: Fluorescence Imagingmentioning

confidence: 99%

The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Secondary and Tertiary Renal Hyperparathyroidism

Dream

Kuo

et al. 2022

Annals of Surgery

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Objective: To develop evidence-based recommendations for safe, effective, and appropriate treatment of secondary (SHPT) and tertiary (THPT) renal hyperparathyroidism. Background: Hyperparathyroidism is common among patients with chronic kidney disease, end-stage kidney disease, and kidney transplant. The surgical management of SHPT and THPT is nuanced and requires a multidisciplinary approach. There are currently no clinical practice guidelines that address the surgical treatment of SHPT and THPT. Methods: Medical literature was reviewed from January 1, 1985 to present January 1, 2021 by a panel of 10 experts in SHPT and THPT. Recommendations using the best available evidence was constructed. The American College of Physicians grading system was used to determine levels of evidence. Recommendations were discussed to consensus. The American Association of Endocrine Surgeons membership reviewed and commented on preliminary drafts of the content. Results: These clinical guidelines present the epidemiology and pathophysiology of SHPT and THPT and provide recommendations for work-up and management of SHPT and THPT for all involved clinicians. It outlines the preoperative, intraoperative, and postoperative management of SHPT and THPT, as well as related definitions, operative techniques, morbidity, and outcomes. Specific topics include Pathogenesis and Epidemiology, Initial Evaluation, Imaging, Preoperative and Perioperative Care, Surgical Planning and Parathyroidectomy, Adjuncts and Approaches, Outcomes, and Reoperation. Conclusions: Evidence-based guidelines were created to assist clinicians in the optimal management of secondary and tertiary renal hyperparathyroidism.

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“…Subsequently, the best remnant is chosen before resecting any parathyroid tissue. 13 Further, ICG angiography fluorescence quantification is scored subjectively by the surgeons, which could explain the discrepancy in quantifying the intensity of fluorescence. Nevertheless, the visual difference between a nonperfused gland and a well-perfused gland is clearly apparent in our study (Fig.…”

Section: Discussionmentioning

confidence: 99%

“…2). 10,13 Special attention was paid to avoiding application of clips onto the parathyroid hila where the vessels are located. Occasionally, a normal looking parathyroid gland was left in place entirely.…”

Section: Methodsmentioning

confidence: 99%

Indocyanine Green Angiography in Subtotal Parathyroidectomy: Technique for the Function of the Parathyroid Remnant

Fortuny

Sadowski

Belfontali

et al. 2016

Journal of the American College of Surgeons

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Subtotal Parathyroidectomy Under Indocyanine Green Angiography

Cited by 13 publications

References 0 publications

Randomized clinical trial of intraoperative parathyroid gland angiography with indocyanine green fluorescence predicting parathyroid function after thyroid surgery

Randomized clinical trial of intraoperative parathyroid gland angiography with indocyanine green fluorescence predicting parathyroid function after thyroid surgery

The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Secondary and Tertiary Renal Hyperparathyroidism

Indocyanine Green Angiography in Subtotal Parathyroidectomy: Technique for the Function of the Parathyroid Remnant

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