On indocyanine green fluorescence and autofluorescence in thyroid and parathyroid surgery: A scoping systematic review

Abstract

• We acknowledge the feasibility of using ICG and AF as a powerful tool for the identification of PG more effectively than with classic methods or the naked eye • These results are encouraging towards the use of such techniques intraoperatively • Further research is needed to obtain high-quality evidence showing a possible reduction in postoperative hypocalcaemia rates and clinical symptoms that would justify the use of these techniques in routine surgical practice. Autofluorescence (AF) and Indocyanine Green Fluorescence (ICG) were used for the first time for parathyroid gland identification in 2011 and 2015, respectively, during thyroidectomy and parathyroidectomy. Authors reported promising results. We aim to understand the impact on postoperative biochemical and clinical outcomes of these new techniques, as well as their influence on the intraoperative identification of parathyroid glands, the related technical challenges and their cost-effectiveness. A systematic search of PubMed/MEDLINE was performed with the help of MeSH and following the PRISMA guidelines. Overall, 58 studies were included dating from 2008 to August 2020 in English, German, Spanish, and French. Due to the mainly observational nature of the papers on the topic, letters to the editor and responses to previous papers were included. Papers combining the use of both techniques in the same cohort were included. We analysed a total of 3 RCTs, 33 observational studies, and 22 case series or reports. The use of AF/ICG increased the surgeon's confidence and demonstrated a better sensitivity for parathyroid gland identification in both thyroidectomies and parathyroidectomies compared to other techniques. Adverse events were uncommon. After reviewing the literature, we acknowledge the feasibility of using ICG and AF as a powerful tool for the identification of parathyroid glands more effectively than with classic methods or the naked eye. These results are encouraging towards the use of such techniques intraoperatively. However, further research is needed to obtain high-quality evidence showing a possible reduction in postoperative hypocalcaemia rates and clinical symptoms that would justify the use of these techniques in routine surgical practice.