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Learning curve in autofluorescence-guided thyroid surgery.

Ali Abood1, Therese Ovesen1, Jacob Bach2

  • 1Department of Otorhinolaryngology, Goedstrup Hospital, Herning, Denmark.

Frontiers in Endocrinology
|April 8, 2026
PubMed
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Surgeons require at least 30 thyroid surgery procedures to master near-infrared autofluorescence (NIRAF) for consistent parathyroid gland (PG) identification and transplantation. This highlights the need for structured training in NIRAF technology.

Area of Science:

  • Surgical Oncology
  • Medical Imaging Technology
  • Endocrinology

Background:

  • Near-infrared autofluorescence (NIRAF) is an emerging adjunct for parathyroid gland (PG) identification during thyroid surgery.
  • The influence of a learning curve on the intraoperative application of NIRAF is not well-established.
  • This study investigates the learning curve associated with NIRAF-guided thyroid surgery.

Purpose of the Study:

  • To evaluate and quantify the learning curve in the application of NIRAF during thyroid surgery.
  • To determine the number of procedures required for surgeons to achieve consistent NIRAF utilization.
  • To assess the impact of NIRAF learning on parathyroid gland autotransplantation rates.

Main Methods:

  • Retrospective cohort study of 130 patients undergoing NIRAF-guided thyroid surgery (2021-2023).
Keywords:
autofluorescencehypoparathyroidismlearning curveparathyroid glandsthyroid surgery

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  • Two surgeons' application of NIRAF was documented via standardized forms after each procedure.
  • Primary outcome: minimum procedures per surgeon for consistent NIRAF use or stable PG autotransplantation.

    • Main Results:

    • NIRAF was most frequently used on specimens and before lower thyroid pole dissection.
    • Both surgeons showed increasing NIRAF consistency over time (p<0.05).
    • Initial high PG autotransplantation rates decreased over time, stabilizing after approximately 30 procedures for both surgeons.

    Conclusions:

    • A significant learning curve exists for NIRAF-guided thyroid surgery.
    • A minimum of 30 procedures per surgeon is needed for consistent NIRAF application and stable PG autotransplantation.
    • Structured implementation and targeted training are crucial for integrating NIRAF technology effectively.