Indocyanine green fluorescence in parathyroidectomy: enhancing efficiency through real-time adenoma identification

Intraoperative identification of parathyroid adenomas can be challenging due to their anatomical variability and the limitations of preoperative imaging. This study aimed to evaluate the impact of indocyanine green (ICG) fluorescence imaging on operative efficiency and surgical outcomes in parathyroidectomy, employing a standard near-infrared (NIR) endoscopic system.

We conducted a prospective interventional study with retrospective controls. Patients undergoing parathyroidectomy for primary hyperparathyroidism were included. The study group received intravenous ICG for intraoperative fluorescence imaging to aid parathyroid gland identification. Standard protocols, including preoperative imaging, intraoperative quick parathyroid hormone (qPTH) measurements, and frozen section analysis, were followed in both groups. Operative times and clinical outcomes were compared between ICG-assisted and standard procedures.

Seventy-six patients were included: 19 in the ICG group and 57 in the control group. The median net operative time (cutting-to-end) was significantly shorter in the ICG group (59 vs. 79 min; p = 0.002), while entry-to-cutting time was slightly longer (44 vs. 35 min; p = 0.014). Although the total operative time was shorter in the ICG group (109 vs. 123 min), this difference was not statistically significant (p = 0.060). A ≥ 50% reduction in qPTH was achieved in 94.7% vs. 89.5% (p = 0.672), and adenoma confirmation was 100% vs. 96.5% (p = 1.0), respectively.

ICG fluorescence is a cost-effective adjunct to standard parathyroidectomy, offering real-time gland visualization and potentially reducing operative times. Its integration into the routine surgical workflow may enhance intraoperative efficiency and outcomes.