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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.
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