Intraoperative Detection of Parathyroid Glands: A Systematic Review and Novel Low‐Tech Alternative

Abstract

Objectives: (1) Perform systematic review of the literature discussing methods of intraoperative detection of parathyroid glands. (2) Determine the feasibility of a low-cost visual identification method using cell phone camera and photographic color analysis. Methods: A systematic review of the literature was undertaken to characterize experimental and existing techniques for real-time, intraoperative detection of parathyroid glands, a quest meant to reduce the incidence of post-thyroidectomy hypoparathyroidism. As an alternative to published techniques, photographs were taken during thyroid and other central neck surgery, using a variety of cell phone-based cameras, under variable lighting conditions. An app used for red-green-blue (RGB) color analysis was employed to stratify known parathyroid tissue and surrounding fat and thyroid gland by RGB content. Results: The majority of published techniques were dependent on specialized, high-tech, and high-cost imaging equipment such as optical coherence tomography, or patient exposure to chemicals such as methylene blue. RGB analysis of camera phone photographs revealed a consistent pattern of red saturation in parathyroid tissue, regardless of lighting conditions or camera type. Using the same app to subtract red from the photograph visually enhanced the difference between parathyroid and surrounding fat and thyroid and confirmed the RGB findings. Conclusions: Photographic RGB analysis used by the amateur photographer at little cost shows promise as an intraoperative parathyroid detection method. Cell phone photography is universally available, and this technique can be employed in a low-resource setting to prevent inadvertent removal of parathyroid tissue.