Intraoperative Autofluorescence and Indocyanine Green Angiography for the Detection and Preservation of Parathyroid Glands
Abstract
:1. Introduction
2. Discussion
3. Conclusions
Author Contributions
Conflicts of Interest
Abbreviations
PG | Parathyroid gland |
PGs | Parathyroid glands |
PTH | Parathyroid hormone |
NIRAF | Near-infrared auto-fluorescence |
NIR | Near-infrared |
ICG | Indocyanine green |
TT | Total thyroidectomy |
PHPT | Primary hyperparathyroidism |
4-ICG | 4-gland indocyanine green (score) |
AF | Auto fluorescence |
References
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Author | Year | Type | Reduction of Hypoparathyroidism | Reduction in Inadvertent Resection of PG | Number of Patients | Increase in PG Detection | Key Notes |
---|---|---|---|---|---|---|---|
Benmiloud et al. [22] | 2019 | randomized controlled clinical trial | Yes, from 22 to 9% —PTH (p = 0.007) | Yes, from 12 to 3% (p = 0.006) | 241 | N/A | NIRAF helped reduce the rates of temporary postoperative hypocalcemia, parathyroid autotransplantation, and inadvertent parathyroid resection |
Dip et al. [23] | 2019 | randomized controlled clinical trial | Yes, from 16.5 to 8.2% —hypocalcemia rates (p < 0.103) | N/A | 170 | Yes, from 2.6 to 3.5 (p < 0.001) | NIRAF increased and allowed the earlier intraoperative identification of parathyroid glands compared to white light alone |
DiMarco et al. [24] | 2019 | randomized controlled clinical trial | No | No | 269 | N/A | NIRAF did not minimize inadvertent parathyroidectomy or postsurgical hypocalcemia in this study |
Kahramangil et al. [25] | 2018 | retrospective Institutional review | N/A | N/A | 210 | Yes | NIFI facilitated PG identification by detecting gland AF, before conventional recognition by the surgeon |
Falco et al. [26] | 2017 | retrospective review | N/A | N/A | 74 | Yes from 2.5 to 3.7 (p < 0.001) | NIRAF significantly increased the number of PGs identified during thyroid and parathyroid surgery |
Benmiloud et al. [27] | 2018 | before and after controlled study | Yes, from 20.9 to 5.2% —hypocalcemia rates (p < 0.001) | Yes, from 7.2 to 1.1% | 513 | N/A | NIRAF use during total thyroidectomy significantly reduced postoperative hypocalcemia, improved parathyroid identification, and reduced rates of autotransplantation |
Author | Year | Nb pt | Intervention | Key Points | Conclusions |
---|---|---|---|---|---|
Lang et al. [37] | 2017 | 70 | TT | Greatest ICG correlated with postoperative normal PTH. | ICGA is a promising operative adjunct in determining residual parathyroid gland function and predicting postoperative hypocalcemia risk after total thyroidectomy. |
Rudin et al. [34] | 2019 | 210 | TT | At least two vascularized glands on ICGA may predict postoperative parathyroid gland function. | ICGA is a novel technique that may improve the assessment of parathyroid gland blood supply compared to visual inspection. |
Razavi et al. [38] | 2019 | 111 | TT | No significant difference in mean PTH changes at the end of surgery, symptomatic hypocalcemia, or length of stay between surgeries performed with and without ICG. | Low-flow ICG patterns are not associated with postoperative PTH changes or transient hypocalcemia and may lead to unnecessary parathyroid auto transplantation. |
Gálvez-Pastor et al. [39] | 2019 | 39 | TT | Patients with postoperative hypocalcemia had a lower 4-ICG score. The 4-ICG score showed good discrimination in terms of predicting postoperative hypocalcemia. | The 4-ICG score predicts postoperative hypocalcemia and correlates well with postoperative parathyroid function in patients undergoing total thyroidectomy for multinodular goiter. |
Jin et al. [40] | 2019 | 26 | TT | In patients with at least one parathyroid gland with an ICG score of 2 postoperative PTH levels were in the normal range. | Fluorescence imaging system applied with indocyanine green is a safe, easy, and effective method for protecting the parathyroid glnd and predicting postoperative hypoparathyroidism. |
Vidal Fortuny et al. [33] | 2018 | 196 | TT | One well perfused parathyroid gland using ICGA is a reliable way of predicting the absence of postoperative hypoparathyroidism. | ICGA reliably predicts the vascularization of the parathyroid glands and obviates the need for the postoperative measurement of calcium and PTH. |
Alesina et al. [41] | 2018 | 5 | TT/PHPT | Postoperative day 1 PTH was normal. | Superiority of combined AF/ICG vs. simple visualization to reduce the rate of postop HPOPT has not been demonstrated. |
ICG score 0 | Devascularized parathyroid gland |
ICG score 1 | Moderately well-vascularized parathyroid gland |
ICG score 2 | Well-vascularized parathyroid gland |
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Demarchi, M.S.; Karenovics, W.; Bédat, B.; Triponez, F. Intraoperative Autofluorescence and Indocyanine Green Angiography for the Detection and Preservation of Parathyroid Glands. J. Clin. Med. 2020, 9, 830. https://doi.org/10.3390/jcm9030830
Demarchi MS, Karenovics W, Bédat B, Triponez F. Intraoperative Autofluorescence and Indocyanine Green Angiography for the Detection and Preservation of Parathyroid Glands. Journal of Clinical Medicine. 2020; 9(3):830. https://doi.org/10.3390/jcm9030830
Chicago/Turabian StyleDemarchi, Marco Stefano, Wolfram Karenovics, Benoît Bédat, and Frédéric Triponez. 2020. "Intraoperative Autofluorescence and Indocyanine Green Angiography for the Detection and Preservation of Parathyroid Glands" Journal of Clinical Medicine 9, no. 3: 830. https://doi.org/10.3390/jcm9030830