Abstract
In over 30% of all thyroid surgeries, complications arise from transient and definitive hypoparathyroidism, underscoring the need for real-time identification and preservation of parathyroid glands (PGs). Here, we evaluate the promising intraoperative optical technologies available for the identification, preservation, and functional assessment of PGs to enhance endocrine surgery. We performed a review of the literature to identify published studies on fluorescence imaging in thyroid and parathyroid surgery. Fluorescence imaging is a well-demonstrated approach for both in vivo and in vitro localization of specific cells or tissues, and is gaining popularity as a technique to detect PGs during endocrine surgery. Autofluorescence (AF) imaging and indocyanine green (ICG) angiography are two emerging optical techniques to improve outcomes in thyroid and parathyroid surgeries. Near-infrared-guided technology has significantly contributed to the localization of PGs, through the detection of glandular AF. Perfusion through the PGs can be visualized with ICG, which can also reveal the blood supply after dissection. Near infrared AF and ICG angiography, providing a valuable spatial and anatomical information, can decrease the incidence of complications in thyroid surgery.
Highlights
More than 80,000 thyroid and parathyroid surgeries are performed yearly in the United States for the treatment of both benign and malignant thyroid diseases [1, 2]
We performed a review of the literature to identify published studies on fluorescence imaging in thyroid and parathyroid surgery
The most common complication resulting from inadequate parathyroid glands (PGs) identification and preservation is transient or definitive postoperative hypoparathyroidism, affecting 20–35 and 1–10%, respectively, of thyroidectomy patients [5, 6]
Summary
More than 80,000 thyroid and parathyroid surgeries are performed yearly in the United States for the treatment of both benign and malignant thyroid diseases [1, 2]. The detection of autofluorescence is a dye-free technique that allows noninvasive, real-time identification and precise localization of PGs. The intrinsic fluorophore responsible for this optical effect in PGs is still unknown; evidence suggests that it could be a calcium-sensing or a vitamin D receptor [2, 42]. A spectroscopy probe must be in contact with the tissue to make point-by-point measurements, while an optical NIR fluorescence imaging camera is contactless and provides a larger field of view. Another limitation of this technique is the difficulty of distinguishing between thyroid and parathyroid tissues. Table : Recent studies using near-infrared autofluorescence (NIRAF) imaging for parathyroid glands (PGs) identification during thyroidectomy
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