Abstract
Background
Intraoperative identification of the difficult-to-spot parathyroid gland is critical during surgery for thyroid and parathyroid disease. Recently, intrinsic fluorescence of the parathyroid gland was identified, and a new method was developed for intraoperative detection of the parathyroid with an original fluorescent detection apparatus. Here, we describe a method for intraoperative detection of the parathyroid using a ready-made photodynamic eye (PDE) system without any fluorescent dye or contrast agents.
Methods
Seventeen patients who underwent surgical treatment for thyroid or parathyroid disease at Kagoshima University Hospital were enrolled in this study. Intrinsic fluorescence of various tissues was detected with the PDE system. Intraoperative in vivo and ex vivo intrinsic fluorescence of the parathyroid, thyroid, lymph nodes and fat tissues was measured and analyzed.
Results
The parathyroid gland had a significantly higher fluorescence intensity than the other tissues, including the thyroid glands, lymph nodes and fat tissues, and we could identify them during surgery using the fluorescence-guided method. Our method could be applicable for two intraoperative clinical procedures: ex vivo tissue identification of parathyroid tissue and in vivo identification of the location of the parathyroid gland, including ectopic glands.
Conclusion
The PDE system may be an easy and highly feasible method to identify the parathyroid gland during surgery.
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References
Christou N, Mathonnet M (2013) Complications after total thyroidectomy. J Visc Surg 150:249–256
Kaplan EL, Yashiro T, Salti G (1992) Primary hyperparathyroidism in the 1990s. Ann Surg 215(4):300–317
Sosa JA, Bowman HM, Tielsch JM et al (1998) The importance of surgeon experience for clinical and economic outcomes from thyroidectomy. Ann Surg 228(3):320–330
Erbil Y, Barbaros U, Ozbey N et al (2009) Risk factors of incidental parathyroidectomy after thyroidectomy for benign thyroid disorders. Int J Surg 7:58–61
Zarebczan B, Chen H (2011) Influence of surgical volume on operative failures for hyperparathyroidism. Adv Surg 45:237–248
Westra WH, Pritchett DD, Udelsman R (1998) Intraoperative confirmation of parathyroid tissue during parathyroid exploration: a retrospective evaluation of the frozen section. Am J Surg Pathol 22(5):538–544
Perrier ND, Ituarte P, Kikuchi S et al (2000) Intraoperative parathyroid aspiration and parathyroid hormone assay as an alternative to frozen section for tissue identification. World J Surg 24:1319–1322
Iacobone M, Scarpa M, Lumachi F et al (2005) Are frozen sections useful and cost-effective in the era of intraoperative qPTH assays? Surgery 138(6):1159–1165
Paras C, Keller M, White L et al (2011) Near-infrared autofluorescence for the detection of parathyroid glands. J Biomed Opt 16(6):067012-1–067012-4
McWade MA, Paras C, White LM et al (2013) A novel optical approach to intraoperative detection of parathyroid glands. Surgery 154(6):1371–1377
McWade MA, Paras C, White LM et al (2014) Label-free intraoperative parathyroid localization with near-infrared autofluorescence imaging. J Clin Endocrinol Metab 99(12):4574–4580
McWade MA, Sanders ME, Broome JT et al (2016) Establishing the clinical utility of autofluorescence spectroscopy for parathyroid detection. Surgery 159:193–202
Yokoyama J, Ito S, Ohba S et al (2011) A novel approach to translymphatic chemotherapy targeting sentinel lymph nodes of patients with oral cancer using intra-arterial chemotherapy—preliminary study. Head Neck Oncol. doi:10.1186/1758-3284-3-42
Miyashiro I, Miyoshi N, Hiratsuka M et al (2008) Detection of sentinel node in gastric cancer surgery by indocyanine green fluorescence imaging: comparison with infrared imaging. Ann Surg Oncol 15(6):1640–1643
Kitai T, Inomoto T, Miwa M et al (2005) Fluorescence navigation with indocyanine green for defecting sentinel lymph nodes in breast cancer. Breast Cancer 12(3):211–215
Ishizawa T, Tamura S, Masuda K et al (2009) Intraoperative fluorescent cholangiography using indocyanine green: a biliary road map for safe surgery. J Am Coll Surg 208(1):e1–e4
Kai K, Satoh S, Watanabe T et al (2010) Evaluation of cholecystic venous flow using indocyanine green fluorescence angiography. J Hepatobiliary Pancreat Sci 17:147–151
Desmettre T, Devoisselle JM, Mordon S (2000) Fluorescence properties and metabolic features of indocyanine green (ICG) as related to angiography. Surv Ophthalmol 45(1):15–27
Kusano M, Kokudo N, Toi M et al (2016) ICG fluorescence imaging and navigation surgery. Springer, Tokyo, pp 21–27
Japanese Society of Thyroid Surgery (2015) General rules for the description of thyroid cancer. Kanehara & Co. Ltd, Tokyo
Funahashi H, Yasuyuki S, Imai T et al (1993) Our technique of parathyroid autotransplantation in operation for papillary thyroid carcinoma. Surgery 114:92–96
Kikumori T, Imai T, Tanaka Y et al (1999) Parathyroid transplantation with total thyroidectomy for thyroid carcinoma: long-term follow up grafted parathyroid function. Surgery 125:504–508
Patel HP, Chadwick DR, Harrison BJ et al (2012) Systematic review of intravenous methylene blue in parathyroid surgery. Br J Surg 99:1345–1351
Tummers QRJG, Schepers A, Hamming JF et al (2015) Intraoperative guidance in parathyroid surgery using near-infrared fluorescence imaging and low-dose methylene blue. Surgery 158:1323–1330
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Shinden, Y., Nakajo, A., Arima, H. et al. Intraoperative Identification of the Parathyroid Gland with a Fluorescence Detection System. World J Surg 41, 1506–1512 (2017). https://doi.org/10.1007/s00268-017-3903-0
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DOI: https://doi.org/10.1007/s00268-017-3903-0