The anatomical basis for preserving the blood supply to the parathyroids during thyroid surgery, and a review of current technologic advances

Shaari, Ariana L.; Spaulding, Sarah L.; Xing, Monica H.; Yue, Lauren E.; Machado, Rosalie; Moubayed, Sami P.; Mundi, Neil; Chai, Raymond L.; Urken, Mark L.

doi:10.1016/j.amjoto.2021.103161

Cited by 5 publications

(5 citation statements)

References 31 publications

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“…Further, the vascularization of PGs is fragile ( 44 ). Most of the superior and inferior PGs receive blood supplies from the inferior thyroid artery.…”

Section: Description Of Parathyroid Glandmentioning

confidence: 99%

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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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“…Further, the vascularization of PGs is fragile ( 44 ). Most of the superior and inferior PGs receive blood supplies from the inferior thyroid artery.…”

Section: Description Of Parathyroid Glandmentioning

confidence: 99%

“…Therefore, in thyroid surgery, simple and efficient auxiliary means to identify the PGs are highly desirable (Figure 2 and Table 2). Further, the vascularization of PGs is fragile (44). Most of the superior and inferior PGs receive blood supplies from the inferior thyroid artery.…”

Section: Description Of Parathyroid Gland 21 Anatomy Of Parathyroid G...mentioning

confidence: 99%

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

et al. 2023

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“…4 The best way to avoid this complication remains the clear identification of the parathyroid glands by meticulous tissue dissection and careful ligation of the terminal arterial branches of the thyroid gland, in order to avoid devascularization of the parathyroid gland. 5 If this is not possible, parathyroid reimplantation during total or subtotal thyroidectomy has proven to be an effective and valuable tool currently increasingly used in endocrine surgery units. 6 Among the wide variety of reimplantation sites described in the literature, only peripheral ones have the advantages of being able to assess graft vitality by the ratio between serum intact parathormone (iPTH) levels of the 2 arms.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

5-year Follow-up of Reimplanted Parathyroid Glands in Forearm Subcutaneous Tissue During Thyroidectomy. A Confirmation of Graft Vitality in a Large Series of Patients

Lelli,

Micalizzi,

Gurrado

et al. 2024

The American Surgeon™

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Introduction The aim of this study is to assess the outcomes of parathyroid gland reimplantation with PR-FaST technique in patients undergoing thyroid surgery, focusing on graft functionality over a 5-year follow-up period. Materials and Methods We analyzed data from 131 patients who underwent parathyroid reimplantation using the PR-FaST technique during thyroid surgery due to inadvertent parathyroid removal or evident vascular damage. Postoperative evaluations included serum calcium (Ca), magnesium (Mg), and phosphorus (P) analyses on the 1st and 2nd postoperative days, at 10 days, and at 1, 3, 6 months, 1 year, and 5 years of follow-up. Additionally, the mean values of serum intact parathyroid hormone (iPTH) concentration were measured from blood samples collected from both the reimplanted arm (iPTH RA) and non-reimplanted arm (iPTH NRA) within the same period. Results Among 131 patients, at 10 days post-surgery, only 46 patients (35.1%) out of 131 exhibited graft viability (iPTH ratio >1.5). This percentage increased to 72.8% (94 patients) after 1 month and further to 87.8% (108 patients) after 3 months post-surgery. At 1 year, 84.7% of patients showed good graft functionality. After 5 years, the percentage remained stable, with graft viability observed in 81.3% of patients. Only 91 of the initial 131 patients completed follow-up up to 5 years, with a dropout rate of 30.5 %. Conclusions Parathyroid reimplantation using the PR-FaST technique is a viable option for patients undergoing thyroidectomy and has been shown to be a reproducible and effective technique in most patients, with sustained graft functionality and parathyroid hormone production over a 5-year follow-up period.

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“…Moreover, some evident forms can be considered persistent complications, potentially with severe long-term consequences. Once again, the correct assessment of the vascular supply of the parathyroid glands and meticulous surgical technique are crucial for optimizing the results [ 9 , 10 ]. In order to successfully treat hypocalcemia, calcium and vitamin D treatment needs to be properly managed.…”

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confidence: 99%

Editorial: Recent Advances in Thyroid Surgery

Scerrino

Richiusa

Graceffa

et al. 2022

JCM

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The anatomical basis for preserving the blood supply to the parathyroids during thyroid surgery, and a review of current technologic advances

Cited by 5 publications

References 31 publications

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

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

5-year Follow-up of Reimplanted Parathyroid Glands in Forearm Subcutaneous Tissue During Thyroidectomy. A Confirmation of Graft Vitality in a Large Series of Patients

Editorial: Recent Advances in Thyroid Surgery

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