Usefulness of ICG Angiography‐Guided Thyroidectomy for Preserving Parathyroid Function

Llorente, Pablo Moreno; García-Barrasa, Arantxa; Pascua-Solé, Mireia; Videla, Sebastián; Otero, Aurema; Muñoz-de-Nova, José Luis

doi:10.1007/s00268-022-06683-x

Cited by 7 publications

(8 citation statements)

References 25 publications

(27 reference statements)

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“…A total of 1743 articles were screened (Figure 1) and 237 full‐text articles were assessed for eligibility. After careful selection of the articles, 66 studies were eligible for the final synthesis and were included in this review 10,14,23,24,27‐88 …”

Section: Resultsmentioning

confidence: 99%

Management of Postthyroidectomy Hypoparathyroidism and Its Effect on Hypocalcemia‐Related Complications: A Meta‐Analysis

van Dijk,

van Driel,

van Kinschot

et al. 2023

Otolaryngol.--head neck surg.

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ObjectiveThe aim of this Meta‐analysis is to evaluate the impact of different treatment strategies for early postoperative hypoparathyroidism on hypocalcemia‐related complications and long‐term hypoparathyroidism.Data SourcesEmbase.com, MEDLINE, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, and the top 100 references of Google Scholar were searched to September 20, 2022.Review MethodsArticles reporting on adult patients who underwent total thyroidectomy which specified a treatment strategy for postthyroidectomy hypoparathyroidism were included. Random effect models were applied to obtain pooled proportions and 95% confidence intervals. Primary outcome was the occurrence of major hypocalcemia‐related complications. Secondary outcome was long‐term hypoparathyroidism.ResultsSixty‐six studies comprising 67 treatment protocols and 51,096 patients were included in this Meta‐analysis. In 8 protocols (3806 patients), routine calcium and/or active vitamin D medication was given to all patients directly after thyroidectomy. In 49 protocols (44,012 patients), calcium and/or active vitamin D medication was only given to patients with biochemically proven postthyroidectomy hypoparathyroidism. In 10 protocols (3278 patients), calcium and/or active vitamin D supplementation was only initiated in case of clinical symptoms of hypocalcemia. No patient had a major complication due to postoperative hypocalcemia. The pooled proportion of long‐term hypoparathyroidism was 2.4% (95% confidence interval, 1.9‐3.0). There was no significant difference in the incidence of long‐term hypoparathyroidism between the 3 supplementation groups.ConclusionsAll treatment strategies for postoperative hypocalcemia prevent major complications of hypocalcemia. The early postoperative treatment protocol for postthyroidectomy hypoparathyroidism does not seem to influence recovery of parathyroid function in the long term.

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Section: Resultsmentioning

confidence: 99%

Management of Postthyroidectomy Hypoparathyroidism and Its Effect on Hypocalcemia‐Related Complications: A Meta‐Analysis

van Dijk,

van Driel,

van Kinschot

et al. 2023

Otolaryngol.--head neck surg.

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“…Regarding the ICG doses, the dose of 1 ml of ICG was arbitrarily selected as in our experience it was the minimum amount of ICG offering clear visualization of the PGS and its feeding vessels. All the remaining doses (3 ml each) were taken from the fists studies from Vidal et al ( 7 , 16 ) that were also used in all our previous published papers ( 15 , 18 ). However, final consensus regarding the ICG doses has not been published yet.…”

Section: Discussionmentioning

confidence: 99%

Indocyanine green (ICG) angiography-guided thyroidectomy: description of surgical technique

Llorente¹,

Pascua-Solé²,

García-Barrasa³

et al. 2023

Front. Surg.

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BackgroundPostoperative hypoparathyroidism is the most common complication after total thyroidectomy and, when becomes permanent, lead to a myriad of clinical symptoms, long-term need of calcium and vitamin D supplementation and negative impact on the patient's health-related quality of life. Any surgical innovation that could reduce complications and improve outcomes of patients undergoing total thyroidectomy deserves to be considered. Angiography-Guided Thyroidectomy has been proposed as a modification of the standard technique of thyroidectomy aimed to identifying the vascular pattern of the parathyroid glands to maximize efforts for preserving functioning glands at the time of operation. Our aim is to provide a technical description of this procedure based on the use of indocyanine green (ICG) angiography to standardize this technique.MethodsThe surgical steps that are followed during a total thyroidectomy are modified due to previous visualization of the feeding vessels of the parathyroid glands according to fluorescence of the vascular mapping obtained by ICG angiography prior to thyroidectomy. The first step is to perform an ICG angiography to assess anatomical features of the feeding vasculature of the parathyroid glands, which allows precise surgical dissection for preservation of the glands. Once the viability of the parathyroids has been evaluated angiographically, thyroidectomy is performed in a second step.ConclusionsICG angiography-guided thyroidectomy may be effective to preserve the largest number of better perfused parathyroid glands, which would contribute to reduce the risk of postoperative and permanent hypoparathyroidism. It can be successfully and safely implemented in thyroid surgery and standardization of the technique is necessary to homogenize this procedure in the future, allowing a better comparation of the results to be published.

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“…In a previous single-center study, it was found that in a prospective cohort of patients in which ICG arteriography was performed before removal of the thyroid gland, the rate of permanent hypoparathyroidism was 0% as compared with 11.9% in a cohort of historical controls ( 14 ). Based on a more conservative approach, a rate of permanent hypoparathyroidism of 2% is estimated in the ICG angiography-guided thyroidectomy and 8% in the control group.…”

Section: Methodsmentioning

confidence: 98%

“…The rates of early and permanent hypocalcemia were significantly lower in the angiography-guided thyroidectomy group (5.6% vs. 26.2%, p = 0.011, and 0% vs. 11.9%, p =0.032, respectively) than in controls. Moreover, a significant higher rate of well vascularized parathyroids at the end of the surgery (score 2) in the angiography-guided thyroidectomy group (52.9% vs. 39.2%, p = 0.018) was also seen ( 14 ). Results obtained in this cohort study provided the rationale for the design of a randomized controlled clinical trial.…”

Section: Introductionmentioning

confidence: 92%

“…In a previous study of our group, a comparison of immediate and permanent hypocalcemia was made in two cohorts of patients who underwent total thyroidectomy and ICG-angiography ( 14 ). In patients included in the prospective cohort (n = 36), ICG-angiography was performed after identification of the parathyroid glands to show their vascular supply prior to surgical removal of the thyroid gland (angiography-guided thyroidectomy), whereas in the historical comparative cohort (n = 84), ICG-angiography was performed only at the end of the surgery.…”

Section: Introductionmentioning

confidence: 99%

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Indocyanine green angiography-guided thyroidectomy versus conventional thyroidectomy for preserving parathyroid function: study protocol for a randomized single-blind controlled trial

Llorente¹,

González²,

Pascua-Solé³

et al. 2023

Front. Endocrinol.

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IntroductionAngiography with indocyanine green (ICG) fluorescence performed before thyroidectomy would allow identification of the vascularization of parathyroid glands, maximizing efforts for preserving functioning glands intraoperatively. The rationale of the study was based on the hypothesis that showing the vascular pattern of the parathyroid glands by means of ICG angiography before performing the thyroidectomy could prevent permanent hypoparathyroidism.Methods and analysisWe propose a randomized single-blind controlled and multicenter clinical trial to assess the efficacy and safety of ICG angiography-guided thyroidectomy to identify the vascular pattern of the parathyroid glands versus conventional thyroidectomy in patients scheduled for elective total thyroidectomy. Patients will be randomized 1:1 to ICG angiography-guided thyroidectomy (experimental group) or conventional thyroidectomy (control group). Patients in the experimental group will undergo ICG angiography before thyroidectomy to identify the feeding vessels of the parathyroid glands and then, post-thyroidectomy ICG angiography to predict immediate parathyroid gland function by scoring the degree of fluorescence of the glands. Patients in the control group will undergo post-thyroidectomy ICG angiography only. The primary outcome measure will be the rate of patients with permanent hypoparathyroidism. Secondary outcome measures will be rate of postoperative hypoparathyroidism, the percentage of well vascularized parathyroid glands remaining in situ, the levels of iPTH and serum calcium after surgery and the influence of the type of vascular pattern of the parathyroid glands over these outcomes, as well as the safety profile of ICG angiography.DiscussionThe results will contribute to adopt a new surgical strategy based on intraoperative ICG angiography before performing total thyroidectomy, according to which the rate of permanent hypoparathyroidism could be substantially reduced.Clinical trial registrationClinicalTrials.gov. identifier NCT05573828.

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Usefulness of ICG Angiography‐Guided Thyroidectomy for Preserving Parathyroid Function

Cited by 7 publications

References 25 publications

Management of Postthyroidectomy Hypoparathyroidism and Its Effect on Hypocalcemia‐Related Complications: A Meta‐Analysis

Management of Postthyroidectomy Hypoparathyroidism and Its Effect on Hypocalcemia‐Related Complications: A Meta‐Analysis

Indocyanine green (ICG) angiography-guided thyroidectomy: description of surgical technique

Indocyanine green angiography-guided thyroidectomy versus conventional thyroidectomy for preserving parathyroid function: study protocol for a randomized single-blind controlled trial

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