Parathyroid glands viability assessment and identification during surgery with multimodal diffuse reflectance...

Accurate identification and preservation of parathyroid glands (PTG) during thyroidectomy are crucial for minimizing postoperative complications. In this study, we evaluated the effectiveness of diffuse reflectance spectroscopy (DRS) and near infrared autofluorescence (NIRAF) as complementary, non-invasive techniques for real-time PTG identification and characterization during surgery. Our study revealed a correlation between intraoperative DRS-derived oxygenation indexes and parathyroid hormone (PTH) levels, suggesting that DRS may predict PTG perfusion status and subsequent PTH fluctuations, allowing assessment of tissue viability during surgery. As the control, a decrease in oxygenation was assessed during parathyroidectomies when the blood supply to the PTG was stopped by the vessels' ligation. It has been also shown that DRS, reliably distinguishes PTG from surrounding tissues based on their unique reflectance properties. DRS-based classification achieved an F1-score of 0.88, demonstrating its potential as a robust standalone tool for PTG identification. Furthermore, when DRS data were integrated with NIRAF measurements, the classification accuracy improved significantly, achieving an F1-score of 0.98. These findings underscore the potential of combining DRS and NIRAF for superior real-time PTG identification and viability assessment, that could improve surgical outcomes by reducing the postoperative complications related to PTG injury.