Indocyanine Green Fluorescence to Assess Parathyroid Glands Function during MIVAT

Area of Science:

• Endocrine Surgery
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Postoperative hypoparathyroidism is a common complication of total thyroidectomy.
• Parathyroid gland injury or devascularization often causes this complication.

Purpose of the Study:

• To evaluate the feasibility and safety of Indocyanine green (ICG) fluorescence during minimally invasive thyroidectomy.
• To assess ICG's ability to predict parathyroid gland perfusion and guide gland preservation.

Main Methods:

• A case series of 9 patients undergoing minimally invasive video-assisted total thyroidectomy.
• Intravenous administration of a standardized dose of ICG.
• Real-time near-infrared imaging to visualize parathyroid vascularization.

Main Results:

• ICG clearly visualized parathyroid gland vascularization.
• Well-perfused glands were preserved, and poorly perfused glands were auto-transplanted.
• Two patients experienced transient hypocalcemia, correlating with ICG evaluation.

Conclusions:

• ICG angiography is a valuable tool in thyroid surgery for optimizing parathyroid preservation.
• This technique may reduce the risk of hypocalcemia after thyroidectomy.
• Further studies are needed to standardize ICG technique and evaluation for definitive hypoparathyroidism outcomes.