Indocyanine green fluorescence-guided parathyroidectomy for primary hyperparathyroidism

Area of Science:

• Endocrinology
• Surgical Oncology
• Medical Imaging

Background:

• Parathyroid gland localization is crucial for successful parathyroidectomy.
• Traditional localization methods like sestamibi scans can have limitations.

Purpose of the Study:

• To assess the ease and utility of indocyanine green (ICG) fluorescence angiography for intraoperative parathyroid gland localization.

Main Methods:

• ICG fluorescence angiography was employed in 60 parathyroidectomies for primary hyperparathyroidism.
• Intravenous ICG administration guided operative navigation with a fluorescence imaging system.
• Surgeons graded ICG enhancement strength using a standardized scoring system.

Main Results:

• Strong vascular enhancement of parathyroid glands was observed in 71.6% of patients.
• In cases where sestamibi scans failed to localize the adenoma (18 patients), ICG imaging successfully identified the parathyroid adenoma in 100% of these cases.
• Procedures were performed safely with minimal blood loss and short operative times.

Conclusions:

• Indocyanine green angiography is a valuable tool for rapid parathyroid gland identification.
• This technique offers potential for improved surgical outcomes with minimal risk.