STUDY OF INTRAOPERATIVE INDOCYANINE GREEN ANGIOGRAPHY EFFECTIVENESS FOR IDENTIFICATION OF PARATHYROID GLANDS DURING...

Area of Science:

• Endocrinology
• Surgical Oncology
• Medical Imaging

Background:

• Postoperative hypocalcemia is a frequent complication following thyroidectomy.
• It is primarily caused by inadvertent damage or removal of parathyroid glands (PG).
• Accurate identification and preservation of PG are crucial for preventing this complication.

Purpose of the Study:

• To evaluate the efficacy of near-infrared fluorescent imaging with indocyanine green (ICG) angiography for intraoperative PG identification.
• To assess the impact of this technique on preventing postoperative hypocalcemia after total thyroidectomy.
• To compare the need for PG autotransplantation between standard and ICG-assisted procedures.

Main Methods:

• A randomized study involving 58 patients undergoing total thyroidectomy.
• Group 1: Standard thyroidectomy (28 patients).
• Group 2: Near-infrared-assisted thyroidectomy using ICG angiography (30 patients).
• Parathyroid gland autofluorescence and perfusion were assessed using an ICG endoscopic system.
• Serum calcium and parathyroid hormone levels were monitored post-surgery.

Main Results:

• Transient postoperative hypocalcemia occurred in 17.86% of the standard group versus 6.67% in the ICG-assisted group.
• One patient in the standard group developed permanent hypocalcemia, compared to none in the ICG group.
• PG autotransplantation was performed more frequently and objectively in the ICG-assisted group (11 patients) compared to the standard group (4 patients).

Conclusions:

• Near-infrared fluorescent imaging with ICG angiography is a safe and repeatable method for intraoperative PG identification.
• This technique enhances the detection and perfusion assessment of PG.
• ICG imaging allows for more objective determination of the need for PG autotransplantation, reducing postoperative hypocalcemia.