Parathyroid gland detection using an intraoperative autofluorescence handheld imager - early feasibility study

Area of Science:

• Endocrinology
• Surgical Technology
• Medical Imaging

Background:

• Thyroid surgery can inadvertently damage parathyroid glands, leading to hypoparathyroidism and hypocalcemia.
• Accurate identification of parathyroid glands is crucial but relies heavily on surgeon experience and invasive biopsy.
• Near-infrared (NIR) autofluorescence offers a potential non-invasive, real-time solution for parathyroid gland visualization.

Purpose of the Study:

• To evaluate the feasibility and accuracy of a novel NIR autofluorescence imaging prototype (hANDY-I) for intraoperative parathyroid gland identification.
• To assess the potential of the hANDY-I system to improve parathyroid gland visualization during thyroidectomy.

Main Methods:

• A new research prototype, hANDY-I, was utilized. This device features coaxial excitation light and a dual RGB/NIR sensor.
• The system provides simultaneous combined autofluorescence and color imaging to guide anatomical landmark identification.
• The hANDY-I prototype was tested during 23 thyroid surgery procedures.

Main Results:

• The hANDY-I imager was tested on 75 parathyroid glands across 23 thyroidectomy cases.
• A high accuracy rate of 95% was achieved, with 71 out of 75 inspected parathyroid glands showing a strong autofluorescence signal and being correctly identified.
• The prototype demonstrated successful real-time visualization of parathyroid glands.

Conclusions:

• The hANDY-I prototype shows significant promise for real-time, non-invasive parathyroid gland identification during thyroid surgery.
• Further investigation through randomized clinical trials with larger patient cohorts is necessary to confirm its impact on reducing hypoparathyroidism and hypocalcemia.
• This technology has the potential to enhance surgical outcomes and patient safety in thyroid procedures.