Surgical Endoscopy

, Volume 31, Issue 9, pp 3737–3742 | Cite as

Increased identification of parathyroid glands using near infrared light during thyroid and parathyroid surgery

  • Jorge Falco
  • Fernando Dip
  • Pablo Quadri
  • Martin de la Fuente
  • Marcos Prunello
  • Raúl J. RosenthalEmail author



Parathyroid gland (PG) identification during thyroid and parathyroid surgery is challenging. Accidental parathyroidectomy increases the rate of postoperative hypocalcaemia. Recently, autofluorescence with near infrared light (NIRL) has been described for PG visualization. The aim of this study is to analyze the increased rate of visualization of PGs with the use of NIRL compared to white light (WL).

Materials and methods

All patients undergoing thyroid and parathyroid surgery were included in this study. PGs were identified with both NIRL and WL by experienced head and neck surgeons. The number of PGs identified with NIRL and WL were compared. The identification of PGs was correlated to age, sex, and histopathological diagnosis.


Seventy-four patients were included in the study. The mean age was 48.4 (SD ±13.5) years old. Mean PG fluorescence intensity (47.60) was significantly higher compared to the thyroid gland (22.32) and background (9.27) (p < 0.0001). The mean number of PGs identified with NIRL and WL were 3.7 and 2.5 PG, respectively (p < 0.001). The difference in the number of PGs identified with NIRL and WL and fluorescence intensity was not related to age, sex, or histopathological diagnosis, with the exception of the diagnosis of thyroiditis, in which there was a significant increase in the number of PGs visualized with NIRL (p = 0.026).


The use of NIRL for PG visualization significantly increased the number of PGs identified during thyroid and parathyroid surgery, and the differences in fluorescent intensity among PGs, thyroid glands, and background were not affected by age, sex, and histopathological diagnosis.


Thyroid surgery Parathyroid surgery Parathyroid gland identification Endocrine surgery Parathyroid gland autofluorescence Fluorescence 


Compliance with ethical standards


Jorge Falco, Fernando Dip, Pablo Quadri, Martin de la Fuente, Marcos Prunello, and Raul J. Rosenthal have no conflicts of interest or financial ties to disclose. The equipment was provided by Fluoptics® France.


  1. 1.
    McWade MA, Paras C, White LM, Phay JE, Mahadevan-Jansen A, Broome JT (2013) A novel optical approach to intraoperative detection of parathyroid glands. Surgery 154:1371–1377CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Gu J, Wang J, Nie X, Wang W, Shang J (2015) Potential role for carbon nanoparticles identification and preservation in situ of parathyroid glands during total thyroidectomy and central compartment node dissection. Int J Clin Exp Med 8:9640–9648PubMedPubMedCentralGoogle Scholar
  3. 3.
    Okada M, Tominaga Y, Yamamoto T, Hiramitsu T, Narumi S, Watarai Y (2016) Location frequency of missed parathyroid glands after parathyroidectomy in patients with persistent or recurrent secondary hyperparathyroidism. World J Surg 40:595–599CrossRefPubMedGoogle Scholar
  4. 4.
    Dumitras M, Strambu V, Radu PA, Radu PA, Iorga C, Bengulescu I, Popa F (2015) Technical factors involved in parathyroid surgery. Chirurgia 110: 425.PubMedGoogle Scholar
  5. 5.
    Sound S, Okoh A, Yigitbas H, Yazici P, Berber E (2015) Utility of indocyanine green fluorescence imaging for intraoperative localization in reoperative parathyroid surgery. Surg Innov. doi: 10.1177/1553350615613450 PubMedGoogle Scholar
  6. 6.
    McWade MA, Sanders ME, Broome JT, Solórzano CC, Mahadevan-Jansen A (2016) Establishing the clinical utility of autofluorescence spectroscopy for parathyroid detection. Surgery 159:193–203CrossRefPubMedGoogle Scholar
  7. 7.
    Tummers QR, Schepers A, Hamming JF, Hamming JF, Kievit J, Frangioni JV, vn de Velde CJ, Vahrmeijer AL (2015) Intraoperative guidance in parathyroid surgery using near-infrared fluorescence imaging and low-dose methylene blue. Surgery 158:1323–1330CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Phitayakorn R, McHenry CR (2006) Incidence and location of ectopic abnormal parathyroid glands. Am J Surg 191:418–423CrossRefPubMedGoogle Scholar
  9. 9.
    Pattou FN, Pellissier LC, Noël C, Wambergue F, Huglo DG, Proye CA (2000) Supernumerary parathyroid glands: frequency and surgical significance in treatment of renal hyperparathyroidism. World J Surg 24:1330–1334CrossRefPubMedGoogle Scholar
  10. 10.
    Alander JT, Kaartinen I, Laakso A, Pätilä T, Spillmann T, Tuchin VV, Venermo M, Välisuo P (2012) A review of indocyanine green fluorescent imaging in surgery. Int J Biomed Imaging 22:2021. doi: 10.1155/2012/940585 Google Scholar
  11. 11.
    McHenry CR, Speroff T, Wentworth D, Murphy T (1994) Risk factors for postthyroidectomy hypocalcemia. Surgery 116:641–648PubMedGoogle Scholar
  12. 12.
    Pattou F, Combemale F, Fabre S, Carnaille B, Decoulx M, Wemeau JL, Racadot A, Proye C (1998) Hypocalcemia following thyroid surgery: incidence and prediction of outcome. World J Surg 22:718–724CrossRefPubMedGoogle Scholar
  13. 13.
    Sasson AR, Pingpank JF Jr, Wetherington W, Hanlon AL, Ridge JA (2001) Incidental parathyroidectomy during thyroid surgery does not cause transient symptomatic hypocalcemia. Arch Otolaryngol Head Neck Surg 127:304–308CrossRefPubMedGoogle Scholar
  14. 14.
    Wingert DJ, Friesen SR, Iliopoulos JI, Pierce GE, Thomas JH, Hermreck AS (1986) Post-thyroidectomy hypocalcemia. Incidence and risk factors. Am J Surg 152:606–610CrossRefPubMedGoogle Scholar
  15. 15.
    Demeester-Mirkine N, Hooghe L, Van Geertruyden J, De Maertelaer V (1992) Hypocalcemia after thyroidectomy. Arch Surg 127:854–858CrossRefPubMedGoogle Scholar
  16. 16.
    Paras C, Keller M, White L, Phay J, Mahadevan-Jasen A (2011) Near-infrared autofluorescence for the detection of parathyroid glands. J Biomed Opt 16:067012CrossRefPubMedGoogle Scholar
  17. 17.
    Vidal Fortuny J, Belfontali V, Sadowski SM, Karenovics W, Guigard S, Triponez F (2016) Parathyroid gland angiography with indocyanine green fluorescence to predict parathyroid function after thyroid surgery. Br J Surg 103:537–543CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Chakedis JM, Maser C, Brumund KT, Bouvet M (2015) Indocyanine green fluorescence-guided redo parathyroidectomy. BMJ Case Rep. doi: 10.1136/bcr-2015-211778 PubMedGoogle Scholar
  19. 19.
    Zaidi N, Bucak E, Yazici P, Soundararajan S, Okoh A, Yigitbas H, Dural C, Berber E (2016) The feasibility of indocyanine green fluorescence imaging for identifying and assessing the perfusion of parathyroid glands during total thyroidectomy. J Surg Oncol 113:775–778CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Jorge Falco
    • 1
  • Fernando Dip
    • 1
    • 2
  • Pablo Quadri
    • 1
  • Martin de la Fuente
    • 1
  • Marcos Prunello
    • 3
  • Raúl J. Rosenthal
    • 2
    Email author
  1. 1.Hospital de Clínicas “José de San Martín”University of Buenos AiresBuenos AiresArgentina
  2. 2.Department of General Surgery and The Bariatric and Metabolic InstituteCleveland Clinic FloridaWestonUSA
  3. 3.National University of Rosario Santa FeRosarioArgentina

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