Intraoperative Mapping Angiography of the Parathyroid Glands: Description, Advantages, and Limits of the Technique

This video details how to perform real-time intraoperative mapping angiograms of the parathyroid glands (iMAP). Using indocyanine green and fluorescence imaging, the aim of this technique is to enhance the observation of parathyroid vessels, which are often difficult to see with the naked eye. We describe the technique itself, show the kind of images that we can get in real time and discuss the advantages and limits of this novel technique, with several illustrating examples. Either by showing directly the pedicle getting into the parathyroid or by showing the general pattern of vascular arborization, without showing precisely the pedicle of the parathyroid, the iMAP can be useful to guide the dissection in real time, and/or more generally, it can help to improve one's knowledge of vascular anatomy of the parathyroids. This technique is, however, demanding with the current devices, and technical improvements, especially on image processing, are necessary to make it more widely acceptable. Performing real-time iMAPs is feasible and potentially useful. Refinements may make this technique easier. The clinical utility is still to be evaluated. Fares Benmiloud has perceived consulting fees from Fluoptics, outside the present video. Runtime of video: 8 mins 3 secs.