Indocyanine green fluorescence-guided redo parathyroidectomy

Area of Science:

• Endocrinology
• Surgical Oncology
• Medical Imaging

Background:

• Re-operative neck surgery for hyperparathyroidism presents significant technical challenges.
• Accurate localization of parathyroid tissue is crucial to minimize operative time and prevent complications.
• Existing intraoperative localization methods have limitations.

Observation:

• Indocyanine green (ICG) is a near-infrared fluorescent dye with demonstrated utility in preclinical models for parathyroid gland localization.
• No prior studies have reported the use of ICG for parathyroid localization in human patients.
• This study explored ICG's efficacy in identifying a recurrent parathyroid adenoma during re-operative neck surgery.

Findings:

• Following neck tissue exposure, the parathyroid adenoma fluoresced brightly when illuminated with a near-infrared imaging system after ICG administration.
• The fluorescence effectively guided surgical dissection, enabling rapid localization and excision of the adenoma.
• Minimal neck exploration was required, reducing operative time and potential injury to surrounding structures.

Implications:

• Indocyanine green offers a simple, safe, and effective method for intraoperative parathyroid localization in humans.
• This technique has the potential to improve outcomes in re-operative neck surgery for hyperparathyroidism.
• Further clinical investigation is warranted to establish ICG's role in routine surgical practice.