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Utilisation of Near Infrared Autofluorescence in Parathyroid Identification During Thyroidectomy: A Systematic Review
Azfar Javed1, Abdullah Alburaiki1, Neil Sharma1
1Queen Elizabeth Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK.
Objective:
Unintentional parathyroid gland resection during total thyroidectomy can result in permanent hypoparathyroidism and lifelong replacement therapy. Near infrared autofluorescence (NIRAF) imaging may aid intraoperative identification and preservation of the parathyroid glands. This article aims to review NIRAF's effectiveness in the prevention of post-operative hypoparathyroidism.
Design:
Systematic review and meta-analysis reported according to PRISMA guidelines.
Methods:
The electronic databases of MEDLINE, Embase and Cochrane were searched in September 2024. Included articles were randomised controlled trials (RCTs) that studied the use of NIRAF vs. dissection with no intraoperative aids in thyroidectomy. Meta-analysis was performed using a random-effects model. Primary outcomes were postoperative hypocalcaemia and permanent hypoparathyroidism.
Results:
Eight RCTs were included in the final analysis, comprising 1620 patients. Meta-analysis revealed patients undergoing thyroidectomy using NIRAF had a reduced risk of both post-operative hypocalcaemia (OR 0.56, 95% CI: 0.36-0.89, p = 0.01) and persistent hypoparathyroidism (OR 0.44, 95% CI: 0.22-0.89, p = 0.02).
Conclusions:
NIRAF use in thyroidectomy reduces the risk of post-operative hypocalcaemia and post-operative hypoparathyroidism.
