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Karahan SN, Toprak S, Celik B, Ozata IH, Yigci D, Kalender M, Tezelman S, Agcaoglu O. Impact of Indocyanine Green Angiography on Postoperative Parathyroid Function: A Propensity Score Matching Study. J Clin Med 2024; 13:3038. [PMID: 38892750 PMCID: PMC11172910 DOI: 10.3390/jcm13113038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 03/01/2024] [Accepted: 04/07/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Thyroidectomy constitutes an important portion of endocrine surgery procedures and is associated with various complications such as bleeding, recurrent laryngeal nerve injury, and postoperative hypoparathyroidsm. Effective parathyroid preservation during thyroid surgery is crucial for patient well-being, with current strategies heavily reliant on surgeon experience. Among various methods, Indocyanine Green Angiography (ICGA) offers a promising method for intraoperative assessment of parathyroid gland perfusion. Methods: In a retrospective study, patients undergoing bilateral thyroidectomy from January 2021 to January 2023 were analyzed, excluding those with previous thyroidectomy, parathyroid disease, or chronic kidney disease. The study compared a control group (n = 175) with an ICGA group (n = 120), using propensity score matching for statistical analysis. Matched cohorts included 120 patients in each group. The primary outcome of this study was identified as temporary postoperative hypoparathyroidism, with secondary outcomes including the rate of parathyroid reimplantation and the incidence of permanent postoperative hypoparathyroidism. Results: The ICGA group showed significantly more parathyroid autotransplantations (p < 0.01). While not statistically significant, the control group had a higher incidence of temporary postoperative hypoparathyroidism (p < 0.09). Rates of hypocalcemia on postoperative day 1 and permanent hypocalcemia were similar. Subgroup analysis indicated more postoperative day 1 hypoparathyroidism in the control group during central neck dissections (p < 0.049). Conclusions: Intraoperative ICGA use correlated with higher parathyroid autotransplantation and suggested reduced postoperative hypoparathyroidism. Changes in fluorescence intensity following a second ICG injection may provide an objective method to assess parathyroid perfusion. Further large-scale studies are needed to fully understand ICGA's impact on parathyroid preservation.
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Affiliation(s)
- Salih N. Karahan
- Department of General Surgery, School of Medicine, Koc University, Istanbul 34450, Turkey; (S.N.K.); (S.T.); (B.C.); (I.H.O.); (D.Y.); (M.K.); (S.T.)
| | - Safa Toprak
- Department of General Surgery, School of Medicine, Koc University, Istanbul 34450, Turkey; (S.N.K.); (S.T.); (B.C.); (I.H.O.); (D.Y.); (M.K.); (S.T.)
| | - Burak Celik
- Department of General Surgery, School of Medicine, Koc University, Istanbul 34450, Turkey; (S.N.K.); (S.T.); (B.C.); (I.H.O.); (D.Y.); (M.K.); (S.T.)
| | - Ibrahim H. Ozata
- Department of General Surgery, School of Medicine, Koc University, Istanbul 34450, Turkey; (S.N.K.); (S.T.); (B.C.); (I.H.O.); (D.Y.); (M.K.); (S.T.)
| | - Defne Yigci
- Department of General Surgery, School of Medicine, Koc University, Istanbul 34450, Turkey; (S.N.K.); (S.T.); (B.C.); (I.H.O.); (D.Y.); (M.K.); (S.T.)
| | - Mekselina Kalender
- Department of General Surgery, School of Medicine, Koc University, Istanbul 34450, Turkey; (S.N.K.); (S.T.); (B.C.); (I.H.O.); (D.Y.); (M.K.); (S.T.)
| | - Serdar Tezelman
- Department of General Surgery, School of Medicine, Koc University, Istanbul 34450, Turkey; (S.N.K.); (S.T.); (B.C.); (I.H.O.); (D.Y.); (M.K.); (S.T.)
- Department of General Surgery, American Hospital, Istanbul 34365, Turkey
| | - Orhan Agcaoglu
- Department of General Surgery, School of Medicine, Koc University, Istanbul 34450, Turkey; (S.N.K.); (S.T.); (B.C.); (I.H.O.); (D.Y.); (M.K.); (S.T.)
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Sobutay E, Cakit H, Terzioglu T. Assessing Parathyroid Gland Viability and Predicting Postoperative Hypoparathyroidism in Thyroid Surgery: The Utility of Indocyanine Green Angiography. SISLI ETFAL HASTANESI TIP BULTENI 2023; 57:466-472. [PMID: 38268654 PMCID: PMC10805044 DOI: 10.14744/semb.2023.06691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/20/2023] [Accepted: 12/01/2023] [Indexed: 01/26/2024]
Abstract
Objectives Postoperative hypoparathyroidism is a common complication following thyroidectomy, with the potential for significant morbidity and cost. While various techniques have been proposed for intraoperative parathyroid gland (PG) identification and preservation, indocyanine green (ICG) angiography has emerged as a promising method. In this retrospective study, patients who underwent total thyroidectomy with or without central neck dissection were evaluated for the utility of ICG angiography in identifying PGs and the correlation of ICG scores with postoperative parathyroid function. Methods ICG angiography was performed using a standardized protocol, and the degree of PG vascularization was assessed visually. A scoring system was employed based on ICG uptake intensity in PGs, as described in the literature. Pearson's correlation test examined the relationship between the total ICG score and percentage parathyroid hormone (PTH) gradient, postoperative calcium, and PTH levels. In addition, patients with at least one well-vascularized PG were also evaluated. Results Twenty-two patients were included in the study. Significant positive correlations were found between the total ICG score and postoperative PTH levels (r=0.549, p=0.008), and a negative correlation with the percentage of PTH gradient (r=-0.504, p=0.01). However, six patients with well-vascularized PGs on ICG angiography still developed postoperative hypoparathyroidism. Conclusion ICG angiography offers a potential tool for evaluating PG vascularization during thyroidectomy and predicting the risk of postoperative hypoparathyroidism. However, its application should be used judiciously, and the technique should be improved for PG preservation. Further studies are warranted to better understand its benefits and limitations in thyroid surgery.
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Affiliation(s)
- Erman Sobutay
- Department of General Surgery, Koc Foundation American Hospital, Istanbul, Türkiye
| | - Hakan Cakit
- Department of General Surgery, Koc Foundation American Hospital, Istanbul, Türkiye
| | - Tarik Terzioglu
- Department of General Surgery, Koc Foundation American Hospital, Istanbul, Türkiye
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Grubnik VV, Parfentiev RS, Grubnik YV, Grubnyk VV. Intraoperative indocyanine green angiography for predicting postoperative hypoparathyroidism. Surg Endosc 2023; 37:9540-9545. [PMID: 37721589 DOI: 10.1007/s00464-023-10466-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/06/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Postoperative hypocalcemia is a common complication of thyroidectomy. This problem is most often associated with accidental devascularization or excision of the parathyroid glands (PG). AIM Aim was to study near-infrared (NIR) fluorescent imaging with intraoperative PG indocyanine green (ICG) angiography to help identify and preserve PG during total thyroidectomy in order to avoid postoperative hypocalcemia. MATERIAL AND METHODS From 2017 to 2022, a total of 92 patients underwent total thyroidectomy at Odessa Regional Hospital. Indications for surgery were multinodular goiter (n = 42), thyroid cancer (n = 43), and Graves' disease (n = 7). By randomization all patients were divided into two groups: in the control group, 48 patients underwent standard total thyroidectomy, and in the main group, 44 patients underwent NIR-assisted total thyroidectomy with ICG angiography. Serum calcium and parathyroid hormone levels were compared between the two groups of patients in 1, 7-15 days after surgery and then 3, 6 months later. RESULTS In the control group, based on a visual assessment of the PG, autotransplantation of the PG was conducted in only five cases. In the second group, autotransplantation was performed in 16 patients. The transient postoperative hypocalcemia was observed in 8 patients of the control group (16, 70%) and in the 2 patients of ICG group (4, 50%) on 5-10 postoperative days. In the first group, 2 patients at 3 months after surgery had permanent hypocalcaemia. CONCLUSION NIR fluorescent imaging with intraoperative PG ICG angiography is a safe and an easily repeatable method. This technique provides improved detecting and assessment of the perfusion of the PG. The need for autotransplantation of the PG can be determined more objectively using ICG imaging than simple visualization.
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Affiliation(s)
- Volodymyr V Grubnik
- Odessa National Medical University, Dobrovolskoho Avenue 90, App. 78, Odesa, Ukraine
| | - Roman S Parfentiev
- Odessa National Medical University, Dobrovolskoho Avenue 90, App. 78, Odesa, Ukraine
| | - Yurii V Grubnik
- Odessa National Medical University, Dobrovolskoho Avenue 90, App. 78, Odesa, Ukraine
| | - Viktor V Grubnyk
- Odessa National Medical University, Dobrovolskoho Avenue 90, App. 78, Odesa, Ukraine.
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Vabalayte K, Romanchishen A, Somova A. Intraoperative prevention of postoperative hypoparathyroidism. Front Endocrinol (Lausanne) 2023; 14:1206881. [PMID: 38027177 PMCID: PMC10663325 DOI: 10.3389/fendo.2023.1206881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Objective More than 30,000 thyroid surgeries are performed annually in the Russian Federation. The surgeries are relatively safe because of the prevention methods for postoperative complications. Currently, there is no single effective method of postoperative hypoparathyroidism prevention. This complication is frequently reported and may be health and life-threatening. Aim We aimed to estimate the effectiveness of the intraoperative ICG-angiography and intrathyroid injection of Brilliant Green for the prevention of postoperative hypoparathyroidism. Material and methods One hundred and forty-three thyroidectomies were performed. Patients were divided into three groups: intraoperative angiography was used in 24 cases; Brilliant Green was injected in 58 cases to identify parathyroid glands; the visual estimation of the parathyroid preservation was used in 61 cases. Calcium level was measured in all patients before and after surgery. Results Calcium level in the serum before and after surgery was 2.37±0.14 and 2.27±0.17 in Group 1, 2.38±0.16 and 2.21±0.16 in Group 2, and 2.39±0.17 and 2.18±0.19 in Group 3. Postoperative hypocalcemia was more prominent in the group with the visually estimated PTG than in the two other groups. The differences in postoperative calcium levels in Groups 1 and 3 were statistically different. Pre- and postoperative Parathormone levels were 6.2±0.4 in Group 1, 5.6±0.57 in Group 2, and 3.5±0.32 in Group 3. Postoperative levels significantly differed in Groups 1 and 3 (p<0.01) and in Groups 2 and 3 (p<0.05). Conclusions ICG-angiography and intrathyroid injection of the Brilliant Green are safe methods of identification and sparing of the parathyroid glands. The severity of hypocalcemia and hypoparathormonemia in Group 3 shows the necessity of finding new methods in endocrine surgery to improve patient outcomes.
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Affiliation(s)
| | | | - Aleksandra Somova
- Federal State Budgetary Educational Institution of Higher Education “Saint-Petersburg State University”, St. Petersburg, Russia
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Somova SD, Vabalayte KV, Romanchishen AF. Safe thyroid surgery: comparison effectiveness of ICG angiography and intrathyroidal brilliant green injection for the prevention of postoperative hypoparathyroidism. ENDOCRINE SURGERY 2022. [DOI: 10.14341/serg12757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND: More than 30,000 surgical interventions on the thyroid gland are performed annually in the Russian Federation. Surgeons are developing methods for the prevention of various postoperative complications, and therefore operations on this organ are considered relatively safe. Currently, there is no unequivocal effective method to prevent postoperative hypoparathyroidism. This complication is often recorded and can threaten the life and health of the patient, which is contrary to the concept of safe surgery.AIM: To evaluate the effectiveness of intraoperative ICG angiography and intrathyroidal injection of brilliant green for the prevention of postoperative hypoparathyroidism.MATERIALS AND METHODS: 143 thyroidectomies were performed. The patients were divided into 3 groups: intraoperative angiography was used in 24 cases, brilliant green was injected to identify the parathyroid glands in 58 cases, visual assessment of the preservation of the parathyroid glands was used in 61 case. Calcium levels were measured in all patients included in the study before and after surgery.RESULTS: Serum calcium levels in the pre- and postoperative period: 2.37±0.14 and 2.27±0.17 in group 1, and 2.38±0.16 and 2.21±0.16 in group 2, 2.39±0.17 and 2.18±0.19 in group 3. Hypocalcemia in the postoperative period was significantly higher in the group with a visual assessment of the parathyroid glands relative to the first two groups. Differences between calcium levels in the postoperative period in groups 2 and 3 were significant with a probability of more than 99% (p<0.01). Significant differences (≥95%) in calcium levels in the postoperative period between groups 1 and 2 (p < 0.05) were obtained. Serum PTH levels in the postoperative period: 6,2±0,4 in group 1, 5,6±0,57 in group 2, 3,5±0,32 in group 3. Differences between PTH levels in the postoperative period in groups 1 and 3 were significant with a probability of more than 99% (p<0.01). Significant differences (≥95%) in PTH levels in the postoperative period between groups 2 and 3 (p < 0.05) were obtained.CONCLUSION: ICG angiography and brilliant green intrathyroidal injection are safe methods for identifying and preserving the parathyroid glands. The high level of hypocalcemia in group 3 indicates the need to search for new techniques in endocrine surgery in order to improve the safety of patients undergoing surgical treatment of thyroid pathology.
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Affiliation(s)
- S. D. Somova
- Scientific and Practical Center for Inflammatory, Metabolic and Oncological Diseases of the Endocrine System Organs of the Institute of High Technologies, St. Petersburg State University
| | - K. V. Vabalayte
- Scientific and Practical Center for Inflammatory, Metabolic and Oncological Diseases of the Endocrine System Organs of the Institute of High Technologies, St. Petersburg State University
| | - A. F. Romanchishen
- Scientific and Practical Center for Inflammatory, Metabolic and Oncological Diseases of the Endocrine System Organs of the Institute of High Technologies, St. Petersburg State University
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Yin S, Pan B, Yang Z, Tang M, Mo H, Li Y, Yi Z, Yin T, Shao C, Yan C, Mo L, Yuan Y, Sun Y, Zhang F. Combined Use of Autofluorescence and Indocyanine Green Fluorescence Imaging in the Identification and Evaluation of Parathyroid Glands During Total Thyroidectomy: A Randomized Controlled Trial. Front Endocrinol (Lausanne) 2022; 13:897797. [PMID: 35784544 PMCID: PMC9243533 DOI: 10.3389/fendo.2022.897797] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/02/2022] [Indexed: 01/19/2023] Open
Abstract
Background and objectives Accurate identification and evaluation of the parathyroid glands (PGs) intraoperatively is critical to reduce the incidence of postoperative hypoparathyroidism after total thyroidectomy. Near-infrared fluorescence imaging (NIFI), including the autofluorescence (AF) and indocyanine green fluorescence (ICGF) imaging, is a promising technique to protect PGs. This study aimed to assess whether the combined use of AF and ICGF could reduce the incidence of postoperative hypoparathyroidism and improve the identification and evaluation of PGs during total thyroidectomy. Methods This randomized controlled trial enrolled 180 patients who were randomized into two groups and underwent total thyroidectomy with unilateral or bilateral central lymph node dissection. In the control group, the PGs were identified and evaluated by the naked eye. In the NIFI group, AF was used to identify the PGs and ICGF was applied to assess the blood perfusion of the PGs in situ. The primary outcome was the incidence of postoperative hypoparathyroidism. The secondary outcomes included the number of identified PGs, autotransplanted PGs, and known preserved PGs in situ. Results The incidence of postoperative transient hypoparathyroidism was significantly lower in the NIFI group than in the control group (27.8% vs. 43.3%, P = 0.029). More PGs were identified in the NIFI group than in the control group (3.6 ± 0.5 vs. 3.2 ± 0.4, P < 0.001). No significant difference was observed in the number of autotransplanted PGs between the two groups (P = 0.134). Compared with the control group, a greater number of known PGs were preserved in situ in the NIFI group (1.3 ± 0.6 vs. 1.0 ± 0.5, P < 0.001). In the NIFI group, only 4.5% of the patients with at least one well-perfused PG (ICG score of 2) developed postoperative hypoparathyroidism, which was significantly lower than that of the control group (34.6%, P < 0.001). Conclusion Combined use of AF and ICGF during total thyroidectomy reduces the risk of transient postoperative hypoparathyroidism, enhances the ability to identify and preserve PGs, and improves the accuracy of evaluating the perfusion of PGs during surgery. Clinical Trial Registration Chinese Clinical Trial Register (www.chictr.org.cn), identifier ChiCTR2100045320. Registered on April 12, 2021.
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Affiliation(s)
- Supeng Yin
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China
| | - Bin Pan
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China
- Graduate School of Medicine, Chongqing Medical University, Chongqing, China
| | - Zeyu Yang
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China
| | - Mi Tang
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China
| | - Hongbiao Mo
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China
| | - Yao Li
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China
| | - Ziying Yi
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China
| | - Tingjie Yin
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China
| | - Cong Shao
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China
| | - Cunye Yan
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China
| | - Linlong Mo
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China
| | - Yuquan Yuan
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China
- Graduate School of Medicine, Chongqing Medical University, Chongqing, China
| | - Yiceng Sun
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China
| | - Fan Zhang
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China
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Heterogeneity in Utilization of Optical Imaging Guided Surgery for Identifying or Preserving the Parathyroid Glands—A Meta-Narrative Review. Life (Basel) 2022; 12:life12030388. [PMID: 35330139 PMCID: PMC8955594 DOI: 10.3390/life12030388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/01/2022] [Accepted: 03/06/2022] [Indexed: 12/02/2022] Open
Abstract
Background: Postoperative hypoparathyroidism is the most common complication after total thyroidectomy. Over the past years, optical imaging techniques, such as parathyroid autofluorescence, indocyanine green (ICG) angiography, and laser speckle contrast imaging (LSCI) have been employed to save parathyroid glands during thyroid surgery. This study provides an overview of the utilized methods of the optical imaging techniques during total thyroidectomy for parathyroid gland identification and preservation. Methods: PUBMED, EMBASE and Web of Science were searched for studies written in the English language utilizing parathyroid autofluorescence, ICG-angiography, or LSCI during total thyroidectomy to support parathyroid gland identification or preservation. Case reports, reviews, meta-analyses, animal studies, and post-mortem studies were excluded after the title and abstract screening. The data of the studies were analyzed qualitatively, with a focus on the methodologies employed. Results: In total, 59 articles were included with a total of 6190 patients. Overall, 38 studies reported using parathyroid autofluorescence, 24 using ICG-angiography, and 2 using LSCI. The heterogeneity between the utilized methodology in the studies was large, and in particular, regarding study protocols, imaging techniques, and the standardization of the imaging protocol. Conclusion: The diverse application of optical imaging techniques and a lack of standardization and quantification leads to heterogeneous conclusions regarding their clinical value. Worldwide consensus on imaging protocols is needed to establish the clinical utility of these techniques for parathyroid gland identification and preservation.
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Ouyang H, Wang B, Sun B, Cong R, Xia F, Li X. Application of Indocyanine Green Angiography in Bilateral Axillo-Breast Approach Robotic Thyroidectomy for Papillary Thyroid Cancer. Front Endocrinol (Lausanne) 2022; 13:916557. [PMID: 35813620 PMCID: PMC9260684 DOI: 10.3389/fendo.2022.916557] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 05/12/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Indocyanine green angiography (ICGA) has been used to identify and preserve the parathyroid glands (PGs), and to evaluate PGs viability and function during thyroid surgery. However, evidence on the utilization of IGCA in thyroid cancer and robotic surgery is lacking. The efficacy of IGCA remains to be evaluated in PTC patients undergoing bilateral axillo-breast approach robotic thyroidectomy (BABA RT) and central neck dissection (CND). METHODS From March 2020 to August 2021, 81 papillary thyroid cancer (PTC) patients receiving total thyroidectomy and CND were enrolled in this retrospective analysis. An intravenous bolus of 7.5 mg ICG was administrated three times in the ICGA group (n=34). Medical records were reviewed and analyzed, including the baseline characteristics, surgical parameters, PGs-related parameters, and perioperative PTH and calcium levels. RESULTS The mean number of total identified PGs and preserved PGs were significantly more in the ICG group than in the control group (3.74 ± 0.45 vs. 3.15 ± 0.55, P<0.001; 3.12 ± 0.64 vs. 2.74 ± 0.57, P=0.007, respectively), as were PTH and calcium levels on POD 1 (23.16 ± 18.32 vs. 6.06 ± 7.74, P=0.039; 2.13 ± 0.11 vs. 2.08 ± 0.08, P=0.024, respectively). While there were no differences in PTH levels on POD 30. Additionally, patients with at least one well vascularized PG had higher ioPTH 3 and PTH on POD 1, which significantly suggested the absence of postoperative hypocalcemia. Although not statistically significant, ICGA seemed superior to relative ioPTH decline and ioPTH 3 in predicting postoperative hypocalcemia. CONCLUSION In PTC patients undergoing BABA RT and CND, ICGA is a simple, safe, effective, and cost-effective tool in better identification and preservation of PGs as well as evaluation of PGs viability and function, with the potential to preserve more PGs, guide more appropriate autotransplantation, and accurately predict postoperative hypocalcemia.
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Affiliation(s)
- Hui Ouyang
- Department of Thyroid Surgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Baojia Wang
- Department of the Operating Room, Xiangya Hospital, Central South University, Changsha, China
| | - Botao Sun
- Department of Thyroid Surgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Rong Cong
- Department of Thyroid Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Fada Xia
- Department of Thyroid Surgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Fada Xia, ; Xinying Li,
| | - Xinying Li
- Department of Thyroid Surgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Fada Xia, ; Xinying Li,
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The utility of indocyanine green (ICG) for the identification and assessment of viability of the parathyroid glands during thyroidectomy. Updates Surg 2021; 74:97-105. [PMID: 34727341 DOI: 10.1007/s13304-021-01202-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 10/26/2021] [Indexed: 10/19/2022]
Abstract
We conducted this study to evaluate the ability of indocyanine green (ICG) and near infra-red fluorescence (NIRF) camera to aid in the identification and assessment of viability of parathyroid glands during thyroid surgery. A prospective observational study was conducted between May and October 2020 among 50 consecutive patients who underwent total thyroidectomy at a single institution. Parathyroid glands were identified under white light during thyroidectomy following which reconstituted ICG was injected through a peripheral vein and the location of parathyroid glands was confirmed. The perfusion to the parathyroid gland was assessed by documenting the fluorescence intensity score (FIS) and the parathyroid angiogram score (PAS). There was no difference in the number of parathyroid glands seen on visual inspection 147 (73.5%) when compared to under NIRF camera, 146 (73%). Though the rate of postoperative hypoparathyroidism was lower in the cohort with FIS 3 (14.2%) compared to score 2 and 1 (28.5% and 100%, respectively), this was not significant (p = 0.35). A significant correlation was noted between a delayed flow on PAS and the development of post-thyroidectomy hypoparathyroidism (p = 0.01). PAS had a sensitivity of 100%, specificity of 88.6%, NPV of 100% and PPV of 55.6% to predict the development of post-thyroidectomy hypoparathyroidism. In this study, there was no additional benefit of ICG and NIRF camera in the identification of parathyroid glands. However, ICG angiogram seems to be a good adjunct for the intraoperative assessment of the viability of the parathyroid glands and accurately predicts the development of postoperative hypoparathyroidism.
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Perigli G, Cianchi F, Giudici F, Russo E, Fiorenza G, Petrone L, Sparano C, Staderini F, Badii B, Morandi A. Thyroidectomy for Cancer: The Surgeon and the Parathyroid Glands Sparing. J Clin Med 2021; 10:4323. [PMID: 34640352 PMCID: PMC8509338 DOI: 10.3390/jcm10194323] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/17/2021] [Accepted: 09/18/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The diagnosis of thyroid cancer is continuously increasing and consequently the amount of thyroidectomy. Notwithstanding the actual surgical skill, postoperative hypoparathyroidism still represents its most frequent complication. The aims of the present study are to analyze the rate of postoperative hypoparathyroidism after thyroidectomy, performed for cancer by a single first operator, without any technological aid, and to compare the data to those obtained adopting the most recent technological adjuncts developed to reduce the postoperative hypoparathyroidism. METHODS During the period 1997-2020 at the Endocrine Surgery Unit of the Department of Clinical and Experimental Medicine of the University of Florence, 1648 consecutive extracapsular thyroidectomies for cancer (401 with central compartment node dissection) were performed. The percentage of hypoparathyroidism, temporary or permanent, was recorded both in the first period (Group A) and in the second, most recent period (Group B). Total thyroidectomies were compared either with those with central compartment dissection and lobectomies. Minimally invasive procedures (MIT, MIVAT, some transoral) were also compared with conventional. Fisher's exact and Chi-square tests were used for comparison of categorical variables. p < 0.01 was considered statistically significant. Furthermore, a literature research from PubMed® has been performed, considering the most available tools to better identify parathyroid glands during thyroidectomy, in order to reduce the postoperative hypoparathyroidism. We grouped and analyzed them by technological affinity. RESULTS On the 1648 thyroidectomies enrolled for the study, the histotype was differentiated in 93.93 % of cases, medullary in 4% and poorly differentiated in the remaining 2.06%. Total extracapsular thyroidectomy and lobectomy were performed respectively in 95.45% and 4.55%. We recorded a total of 318 (19.29%) cases of hypocalcemia, with permanent hypoparathyroidism in 11 (0.66%). In regard to the literature, four categories of tools to facilitate the identification of the parathyroids were identified: (a) vital dye; (b) optical devices; (c) autofluorescence of parathyroids; and (d) autofluorescence enhanced by contrast media. Postoperative hypoparathyroidism had a variable range in the different groups. CONCLUSIONS Our data confirm that the incidence of post-surgical hypoparathyroidism is extremely low in the high volume centers. Its potential reduction adopting technological adjuncts is difficult to estimate, and their cost, together with complexity of application, do not allow immediate routine use. The trend towards increasingly unilateral surgery in thyroid carcinoma, as confirmed by our results in case of lobectomy, is expected to really contribute to a further reduction of postsurgical hypoparathyroidism.
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Affiliation(s)
- Giuliano Perigli
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 6, 50135 Florence, Italy; (G.P.); (F.C.); (E.R.); (G.F.); (F.S.); (B.B.); (A.M.)
| | - Fabio Cianchi
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 6, 50135 Florence, Italy; (G.P.); (F.C.); (E.R.); (G.F.); (F.S.); (B.B.); (A.M.)
| | - Francesco Giudici
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 6, 50135 Florence, Italy; (G.P.); (F.C.); (E.R.); (G.F.); (F.S.); (B.B.); (A.M.)
| | - Edda Russo
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 6, 50135 Florence, Italy; (G.P.); (F.C.); (E.R.); (G.F.); (F.S.); (B.B.); (A.M.)
| | - Giulia Fiorenza
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 6, 50135 Florence, Italy; (G.P.); (F.C.); (E.R.); (G.F.); (F.S.); (B.B.); (A.M.)
| | - Luisa Petrone
- Department of Biomedical, Experimental and Clinical Sciences Mario Serio, University of Florence, Largo Brambilla, 6, 50135 Florence, Italy; (L.P.); (C.S.)
| | - Clotilde Sparano
- Department of Biomedical, Experimental and Clinical Sciences Mario Serio, University of Florence, Largo Brambilla, 6, 50135 Florence, Italy; (L.P.); (C.S.)
| | - Fabio Staderini
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 6, 50135 Florence, Italy; (G.P.); (F.C.); (E.R.); (G.F.); (F.S.); (B.B.); (A.M.)
| | - Benedetta Badii
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 6, 50135 Florence, Italy; (G.P.); (F.C.); (E.R.); (G.F.); (F.S.); (B.B.); (A.M.)
| | - Alessio Morandi
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 6, 50135 Florence, Italy; (G.P.); (F.C.); (E.R.); (G.F.); (F.S.); (B.B.); (A.M.)
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Demarchi MS, Seeliger B, Lifante JC, Alesina PF, Triponez F. Fluorescence Image-Guided Surgery for Thyroid Cancer: Utility for Preventing Hypoparathyroidism. Cancers (Basel) 2021; 13:cancers13153792. [PMID: 34359693 PMCID: PMC8345196 DOI: 10.3390/cancers13153792] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/08/2021] [Accepted: 07/23/2021] [Indexed: 01/09/2023] Open
Abstract
Background: Hypoparathyroidism is one of the most frequent complications of thyroid surgery, especially when associated with lymph node dissection in cases of thyroid cancer. Fluorescence-guided surgery is an emerging tool that appears to help reduce the rate of this complication. The present review aims to highlight the utility of fluorescence imaging in preserving parathyroid glands during thyroid cancer surgery. Methods: We performed a systematic review of the literature according to PRISMA guidelines to identify published studies on fluorescence-guided thyroid surgery with a particular focus on thyroid cancer. Articles were selected and analyzed per indication and type of surgery, autofluorescence or exogenous dye usage, and outcomes. The Methodological Index for Non-Randomized Studies (MINORS) was used to assess the methodological quality of the included articles. Results: Twenty-five studies met the inclusion criteria, with three studies exclusively assessing patients with thyroid cancer. The remaining studies assessed mixed cohorts with thyroid cancer and other thyroid or parathyroid diseases. The majority of the papers support the potential benefit of fluorescence imaging in preserving parathyroid glands in thyroid surgery. Conclusions: Fluorescence-guided surgery is useful in the prevention of post-thyroidectomy hypoparathyroidism via enhanced early identification, visualization, and preservation of the parathyroid glands. These aspects are notably beneficial in cases of associated lymphadenectomy for thyroid cancer.
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Affiliation(s)
- Marco Stefano Demarchi
- Department of Thoracic and Endocrine Surgery and Faculty of Medicine, University Hospitals of Geneva, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva, Switzerland;
- Department of Endocrine Surgery, Lyon Sud University Hospitals, 69310 Pierre Benite, France;
| | - Barbara Seeliger
- IHU—Strasbourg, Institute of Image-Guided Surgery, 67091 Strasbourg CEDEX, France;
- IRCAD, Research Institute against Digestive Cancer, 67091 Strasbourg CEDEX, France
- Department of General, Digestive, and Endocrine Surgery, Strasbourg University Hospitals, 67091 Strasbourg CEDEX, France
- Department of Surgery and Center of Minimally Invasive Surgery, Evangelische Kliniken Essen-Mitte, Academic Teaching Hospital of the University of Duisburg-Essen, 45136 Essen, Germany;
| | - Jean-Christophe Lifante
- Department of Endocrine Surgery, Lyon Sud University Hospitals, 69310 Pierre Benite, France;
- Health Services and Performance Research Lab (EA 7425 HESPER), Université Claude Bernard Lyon 1, 69622 Lyon, France
| | - Pier Francesco Alesina
- Department of Surgery and Center of Minimally Invasive Surgery, Evangelische Kliniken Essen-Mitte, Academic Teaching Hospital of the University of Duisburg-Essen, 45136 Essen, Germany;
- Department of Surgery, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, 86100 Campobasso, Italy
| | - Frédéric Triponez
- Department of Thoracic and Endocrine Surgery and Faculty of Medicine, University Hospitals of Geneva, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva, Switzerland;
- Correspondence: ; Tel.: +41-(0)22-372-78-62
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12
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Near-infrared autofluorescence-based parathyroid glands identification in the thyroidectomy or parathyroidectomy: a systematic review and meta-analysis. Langenbecks Arch Surg 2021; 407:491-499. [PMID: 34322746 DOI: 10.1007/s00423-021-02269-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/06/2021] [Indexed: 01/22/2023]
Abstract
PURPOSE To evaluate the diagnostic accuracy of near-infrared autofluorescence-based identification in the identification of parathyroid glands during thyroidectomy or parathyroidectomy. METHODS The clinical studies were retrieved from PubMed, the Cochrane Central Register of Controlled Trials, Embase, Web of Science, SCOPUS, and Google Scholar. The study protocol was registered on Open Science Framework ( https://osf.io/um8rj/ ). The search period ranged from the date of each database's inception to May 2021. Cohort studies dealing with patients of whom parathyroid glands were detected by near-infrared autofluorescence and confirmed clinically or pathologically during thyroidectomy or parathyroidectomy were included. Editorials, letters, "how-I-do-it" descriptions, other site head and neck tumors, and articles with lack of diagnostic identification data were excluded. True positive, true negative, false positive, and false negative were extracted. The QUDAS ver. 2 was used to evaluate the methodological quality. RESULTS Seventeen studies with 1198 participants were evaluated in this analysis. Near-infrared autofluorescence-based identification of parathyroid glands showed a diagnostic odds ratio of 228.8759 (95% confidence interval, 134.1099; 390.6063). The area under the summary receiver operating characteristic curve was 0.967. The sensitivity, specificity, negative predictive value, and positive predictive value were 0.9693 (0.9491; 0.9816), 0.9248 (0.8885; 0.9499), 0.9517 (0.8981; 0.9778), and 0.9488 (0.9167; 0.9689), respectively. Subgroup analyses were performed to compare two autofluorescence detection methods, because there was high heterogeneity in the outcomes. The diagnostic accuracy was higher in probe-based detection than in image-based detection. CONCLUSIONS Near-infrared autofluorescence-based identification is valuable for identifying the parathyroid glands of patients during thyroidectomy or parathyroidectomy.
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Matson J, Lwin TM, Bouvet M. Rapid intraoperative perfusion assessment of parathyroid adenomas with ICG using a wide-field portable hand-held fluorescence imaging system. Am J Surg 2021; 223:686-693. [PMID: 34407918 DOI: 10.1016/j.amjsurg.2021.07.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/27/2021] [Accepted: 07/18/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Fluorescence angiography (FA) using indocyanine green dye (ICG) has recently been introduced for real-time identification of parathyroid adenomas. However, time to peak fluorescence has not yet been critically evaluated. METHODS This was a retrospective review of parathyroidectomies with ICG FA over a one-year period. RESULTS There were 66 patients with average age of 64 years. The average time to initial fluorescence was 26.7 s and to peak fluorescence was 38.0 s. The time to saline flush administration significantly correlated with times to initial and peak fluorescence (p < .0001). The rate of in-situ fluorescence was 97%. The rates of suspected adenoma detection were 69% for sestamibi scan, 71% for ultrasound, and 96% for CT scan. Imaging was discordant in 13 cases (20%), with the adenoma located on the opposite side of the neck in 4 cases. CONCLUSIONS ICG FA is a rapid and effective adjunct for the intraoperative identification of parathyroid adenomas.
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Affiliation(s)
- Jared Matson
- Department of Surgery, UC San Diego, San Diego, CA, USA
| | - Thinzar M Lwin
- Department of Surgery, UC San Diego, San Diego, CA, USA; Department of Surgical Oncology, Dana Farber Cancer Center, Boston, MA, USA
| | - Michael Bouvet
- Department of Surgery, UC San Diego, San Diego, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA.
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Barbieri D, Indelicato P, Vinciguerra A, Di Marco F, Formenti AM, Trimarchi M, Bussi M. Autofluorescence and Indocyanine Green in Thyroid Surgery: A Systematic Review and Meta-Analysis. Laryngoscope 2020; 131:1683-1692. [PMID: 33247620 DOI: 10.1002/lary.29297] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/10/2020] [Accepted: 11/18/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES/HYPOTHESIS To estimate the impact of optical techniques on prevention of post-operative hypocalcemia and hypoparathyroidism after total thyroidectomy. STUDY DESIGN Systematic review and meta-analysis. METHODS A literature search was conducted in Pubmed, EMBASE, SCOPUS, and Cochrane databases. The main inclusion criteria for eligible articles for meta-analysis were patients with benign or malignant thyroid pathologies who underwent total thyroidectomy, utilization of optical techniques to support PGs preservation, the availability of calcium and/or PTH levels. The primary outcome was to evaluate the variation of calcium and PTH levels when adopting optical technologies compared to standard naked-eye surgery. RESULTS In total, 13 papers with 1484 procedures were included. Pooled proportion for short- and medium-term hypocalcemia rates were 8% (95% CI, 5%:11%) and 1% (95% CI, 0%:4%) for optical techniques, while for naked-eye surgery were 15% (95% CI, 9%:23%) and 5% (95% CI, 2%:9%), respectively. CONCLUSIONS Optical technologies reduced short and medium term hypocalcemia compared to conventional surgery. LEVEL OF EVIDENCE NA Laryngoscope, 131:1683-1692, 2021.
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Affiliation(s)
- Diego Barbieri
- Division of Head and Neck department, Otorhinolaryngology unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Pietro Indelicato
- Division of Head and Neck department, Otorhinolaryngology unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Vinciguerra
- Division of Head and Neck department, Otorhinolaryngology unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Federico Di Marco
- Urological Research Institute (URI), Division of experimental oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Anna Maria Formenti
- Department of Endocrinology, Vita-Salute San Raffaele University and IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Trimarchi
- Division of Head and Neck department, Otorhinolaryngology unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Mario Bussi
- Division of Head and Neck department, Otorhinolaryngology unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
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15
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Enny L, Ramakant P, Singh KR, Rana C, Garg S, Mishra AK. Efficacy of Fluorescein Green Dye in Assessing Intra-Operative Parathyroid Gland Vascularity and Predicting Post-Thyroidectomy Hypocalcaemia- A Novel Prospective Cohort Study. Indian J Endocrinol Metab 2020; 24:446-451. [PMID: 33489851 PMCID: PMC7810046 DOI: 10.4103/ijem.ijem_499_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 08/22/2020] [Accepted: 09/21/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Postoperative hypocalcaemia (POH) after total thyroidectomy (TT) is a common complication. Parathyroid hormone (PTH), an accurate predictor of POH cannot assess intra-operative viability of parathyroid glands (PGs). Different dyes including indocyanine green or carbon nanoparticles have been used, but they are expensive and not widely available. Fluorescein green dye (FD) has been used as a low-cost alternative to study viability of various organs, but seldom tried in visualizing PGs. This novel study aims to assess utility of FD in determining parathyroid viability and predicting POH. MATERIAL AND METHOD Total 72 out of 88 patients undergoing TT between January and December 2019 were included. Two ml of 25% FD was given intravenously before wound closure and attempts were made to visualize PGs under blue light. A numerical score was given according to the number of PGs visualized. Intact-PTH and corrected calcium were measured on postoperative day 1 and patients observed for POH. RESULTS No PGs were visualized in 6 patients, 1 in 13, 2 in 30, 3 in 16 & 4 in 7 patients. Mean PTH was 6, 16.9, 31.6, 33.2 and 48.5 respectively. Corrected-calcium was 7.08, 7.7, 7.9, 8.5 and 8.5 respectively. All patients with score 0 received supplementary IV calcium, while 53.8% (score-1), 30% (score-2), 0% (scores-3, 4) received the same. Sensitivity, specificity and ROC of PG score of ≥2 on FD in predicting POH were 100%, 44% and 0.83 respectively. CONCLUSION FD visualization of parathyroids post TT is feasible and can be used as low cost efficacious method to predict POH.
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Affiliation(s)
- Loreno Enny
- Department of Endocrine Surgery, King Georges Medical University, Lucknow, Uttar Pradesh, India
| | - Pooja Ramakant
- Department of Endocrine Surgery, King Georges Medical University, Lucknow, Uttar Pradesh, India
| | - Kul R. Singh
- Department of Endocrine Surgery, King Georges Medical University, Lucknow, Uttar Pradesh, India
| | - Chanchal Rana
- Department of Pathology, King Georges Medical University, Lucknow, Uttar Pradesh, India
| | - Surubhi Garg
- Department of Endocrine Surgery, King Georges Medical University, Lucknow, Uttar Pradesh, India
| | - Anand K. Mishra
- Department of Endocrine Surgery, King Georges Medical University, Lucknow, Uttar Pradesh, India
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Jin H, Cui M. New Advances of ICG Angiography in Parathyroid Identification. Endocr Metab Immune Disord Drug Targets 2019; 19:936-940. [PMID: 30727933 DOI: 10.2174/1871530319666190206212456] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 01/05/2019] [Accepted: 01/19/2019] [Indexed: 12/27/2022]
Abstract
Objective:
For surgeons, locating parathyroid in thyroidectomy and parathyroidectomy is
critical since parathyroid plays an important role in calcium balance. The fluorescence of parathyroid
has already been found by researchers and the angiography equipment detecting the fluorescence of
parathyroid with indocyanine green has been widely applied. Using the indocyanine green angiography
and looking at the actual fluorescence of in vivo and in vitro tissues, it was possible to identify thyroid,
parathyroid, lymph nodes and fat tissues during the surgical procedure. This mini-review aims to present
the application of indocyanine green angiography in parathyroid detection and discusses the safety
of this method.
Methods:
The relevant data were searched by using the keywords “Indocyanine green,” “Parathyroid,”
and “Identification” and “Protection” in “Pubmed,” “Web of Science” and “China Knowledge Resource
Integrated databases”, and a manual search was done to acquire peer-reviewed articles and reports
about indocyanine green.
Results:
Indocyanine green dye along with the intraoperative fluorescence imaging system is safe in
detecting parathyroid and predicting postoperative hypoparathyroidism.
Conclusion:
The conclusion suggests that indocyanine green angiography is a safe, effective and easy
way to detect parathyroid glands. The conclusion will be of interest to surgeons regarding thyroidectomy
and parathyroidectomy.
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Affiliation(s)
- Hao Jin
- The Second Department of General Surgery, Zhuhai People’s Hospital, No. 79 of Kangning Road, Xiangzhou District, Zhuhai City, Guangdong Province, 519000, China
| | - Min Cui
- The Second Department of General Surgery, Zhuhai People’s Hospital, No. 79 of Kangning Road, Xiangzhou District, Zhuhai City, Guangdong Province, 519000, China
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