Abstract
BackgroundThis study assessed the feasibility of near‐infrared fluorescence imaging with indocyanine green (ICG) to identify the parathyroid glands (PGs) intraoperatively and to assess their perfusion after thyroid resection.MethodsPatients undergoing elective thyroidectomy were enrolled in this prospective study. An intravenous bolus of 7.5 mg ICG was administered twice: the first bolus to identify the PGs before resection of the thyroid and the second to assess vascularization of the PGs after resection.ResultsA total of 30 operations in 26 patients were included. In 17 surgeries (56.7%), fluorescence imaging was of added value, especially to confirm the presence of a suspected PG. No intraoperative or postoperative complications occurred because of the use of ICG.ConclusionNear‐infrared fluorescence imaging with the use of ICG for intraoperative identification of the PGs and the assessment of its vascularization is feasible and safe and can provide more certainty about the location of the PGs.
Highlights
Iatrogenic injury of the parathyroid glands (PGs) is the most common complication after total thyroidectomy.[1]
A descriptive analysis was conducted for the patients' baseline characteristics and the following outcome measurements: total operation time, extra operation time, the presence of PGs in the resected thyroid, number of PGs identified in white light and near-infrared fluorescence (NIRF), occurrence of perioperative complications, and the usefulness of the technique
Because this tissue was so well vascularized, a lot of background fluorescence was present in these patients, making it difficult to distinguish between the cancerous tissue and the PGs based on NIRF imaging
Summary
Iatrogenic injury of the parathyroid glands (PGs) is the most common complication after total thyroidectomy.[1]. A promising technique to visualize healthy and diseased parathyroid tissue has emerged in the use of intraoperative NIRF imaging using intravenously administered indocyanine green (ICG). This safe and rapidly evolving intraoperative imaging modality is described for use in a wide range of surgical procedures, such as identification of the biliary anatomy, assessment of anastomotic perfusion, and sentinel lymph node mapping.[14–16]. A descriptive analysis was conducted for the patients' baseline characteristics and the following outcome measurements: total operation time, extra operation time, the presence of PGs in the resected thyroid, number of PGs identified in white light and NIRF, occurrence of perioperative complications, and the usefulness of the technique. The independent sample t test was used to assess whether there was a relation between the fluorescence intensity and factors, such as malignant or benign disease and normal or low calcium
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