Total thyroidectomy (TT) is responsible for transient postoperative hypocalcemia (PH) in 20-30% of patients. This complication results from surgery-induced parathyroid damage, vascular impairment or unintentional parathyroid resection of these small glands, which can be difficult to identify visually.
Fluoptics introduced lately a Near-infrared (NIR) Fluorescence imaging device able to visualize auto-fluorescence of parathyroid gland during thyroid surgery without injection of any fluorescent dye.
In order to assess the impact of this technology on the post-thyroidectomy transient hypocalcemia rate, we performed a before-after study where we compared all consecutive patients who
underwent TT with the intraoperative use of the Fluobeam® NIR camera (NIR+ group) and those operated on without NIR (NIR- group), by the same surgeon.
Parathyroid glands were identified via NIR camera before they were visualized by the surgeon in 68% of patients in the NIR+group. In the NIR+group, postoperative hypocalcemia rate was significantly lower (5.2% vs 20.9%, p<0.05), mean number of identified parathyroid glands was significantly higher (3.1±0.9 vs 2.6±1.0 per patient, p<0.05) and parathyroid auto-transplantation rates was significantly lower (2.1% vs 15% of patients, p<0.05) than in the NIR- group, although no difference was observed
in inadvertent resection rates.
This trial seems to demonstrate that auto-fluorescence-based visualization of the parathyroid glands using NIR light during total thyroidectomy can significantly reduce postoperative hypocalcemia rates and improve identification and preservation of parathyroid glands.
Eren Berber, "Impact of fluorescence imaging in thyroid surgery
(Conference Presentation)," Proc. SPIE 10478, Molecular-Guided Surgery: Molecules, Devices, and Applications IV, 104780Q (Presented at SPIE BiOS: January 28, 2018; Published: 14 March 2018); https://doi.org/10.1117/12.2293729.5751477456001.
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