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Evaluation of Parathyroid Glands with Indocyanine Green Fluorescence Angiography After Thyroidectomy

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Abstract

Background

Indocyanine green fluorescence angiography (ICGA) is a new adjunct that has been used in surgical procedures to assess blood flow. This study evaluated the utility of ICGA compared to visual inspection to predict parathyroid function, guide autotransplantation and potentially decrease permanent hypoparathyroidism.

Methods

This was a retrospective study of patients who underwent total or near-total thyroidectomy (T-NT) between January 2015 and March 2018. Patients with preoperative hyperparathyroidism and those undergoing reoperation were excluded. Patients who had ICGA were compared to T-NT patients without ICGA. Data were analyzed to assess the frequency of autotransplantation and incidence of hypoparathyroidism between groups.

Results

In total, 210 patients underwent T-NT: 86 with ICGA and 124 without. Autotransplantation was more common in the ICGA group at 36% compared to 12% in the control (p = 0.0001). There was no correlation with at least one normal parathyroid gland on ICGA and postoperative PTH levels (p = 0.75). There was a difference in having normal postoperative PTH when there were at least two normal parathyroid glands (n = 50) compared to patients with less than two normal ICGA glands (n = 36, p = 0.044). Visual assessment and ICGA assessment of vascularity were in agreement, 245/281 (87%). There were 19 glands (6.8%) that would have undergone autotransplant based on visual inspection that had adequate blood supply on ICGA. Transient hypoparathyroidism was present in 45 out of 124 controls (36%) and 32 out of 86 (37%) in the ICG group.

Conclusions

ICGA is a novel technique that may improve the assessment of parathyroid gland blood supply compared to visual inspection. ICGA can guide more appropriate autotransplantation without compromising postoperative parathyroid function. At least two vascularized glands on ICGA may predict postoperative parathyroid gland function.

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References

  1. Edafe O, Antakia R, Laskar N, Uttley L, Balasubramanian SP (2014) Systematic review and meta-analysis of predictors of post-thyroidectomy hypocalcaemia. Br J Surg 101(4):307–320

    Article  CAS  PubMed  Google Scholar 

  2. Chia SH, Weisman RA, Tieu D, Kelly C, Dillmann WH, Orloff LA (2006) Prospective study of perioperative factors predicting hypocalcemia after thyroid and parathyroid surgery. Arch Otolaryngol Head Neck Surg 132(1):41–45

    Article  PubMed  Google Scholar 

  3. Bilezikian JP, Khan A, Potts JT Jr, Brandi ML, Clarke BL, Shoback D et al (2011) Hypoparathyroidism in the adult: epidemiology, diagnosis, pathophysiology, target-organ involvement, treatment, and challenges for future research. J Bone Miner Res 26(10):2317–2337

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Barczynski M, Cichon S, Konturek A, Cichon W (2008) Applicability of intraoperative parathyroid hormone assay during total thyroidectomy as a guide for the surgeon to selective parathyroid tissue autotransplantation. World J Surg 32(5):822–828. https://doi.org/10.1007/s00268-007-9405-8

    Article  PubMed  Google Scholar 

  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. https://doi.org/10.1177/1553350615613450

    Article  PubMed  Google Scholar 

  6. Suh YJ, Choi JY, Chai YJ, Kwon H, Woo JW, Kim SJ et al (2015) Indocyanine green as a near-infrared fluorescent agent for identifying parathyroid glands during thyroid surgery in dogs. Surg Endosc 29(9):2811–2817

    Article  PubMed  Google Scholar 

  7. 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(5):537–543

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Vidal Fortuny J, Karenovics W, Triponez F, Sadowski SM (2016) Intra-operative indocyanine green angiography of the parathyroid gland. World J Surg 40:2378–2381. https://doi.org/10.1007/s00268-016-3493-2

    Article  PubMed  PubMed Central  Google Scholar 

  9. Zaidi N, Bucak E, Okoh A, Yazici P, Yigitbas H, Berber E (2016) The utility of indocyanine green near infrared fluorescent imaging in the identification of parathyroid glands during surgery for primary hyperparathyroidism. J Surg Oncol 113:771–774

    Article  CAS  PubMed  Google Scholar 

  10. Zaidi N, Bucak E, Yazici P, Soundararajan S, Okoh A, Yigitbas H et al (2016) The feasibility of indocyanine green fluorescence imaging for identifying and assessing the perfusion of parathyroid glands during total thyroidectomy. J Surg Oncol 113:775–778

    Article  CAS  PubMed  Google Scholar 

  11. Alander JT, Kaartinen I, Laakso A, Patila T, Spillmann T, Tuchin VV et al (2012) A review of indocyanine green fluorescent imaging in surgery. Int J Biomed Imaging 2012:940585

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Owens SL (1996) Indocyanine green angiography. Brit J Ophthalmol. 80(3):263–266

    Article  CAS  Google Scholar 

  13. Delbridge L (2002) Parathyroid autotransplantation: an essential technique for safe thyroid surgery. ANZ J Surg 72(12):852–853

    Article  PubMed  Google Scholar 

  14. Palazzo FF, Sywak MS, Sidhu SB, Barraclough BH, Delbridge LW (2005) Parathyroid autotransplantation during total thyroidectomy–does the number of glands transplanted affect outcome? World J Surg 29(5):629–631. https://doi.org/10.1007/s00268-005-7729-

    Article  PubMed  Google Scholar 

  15. Richards ML, Bingener-Casey J, Pierce D, Strodel WE, Sirinek KR (2003) Intraoperative parathyroid hormone assay: an accurate predictor of symptomatic hypocalcemia following thyroidectomy. Arch Surg 138(6):632–635 discussion 5-6

    Article  PubMed  Google Scholar 

  16. Noordzij JP, Lee SL, Bernet VJ, Payne RJ, Cohen SM, McLeod IK et al (2007) Early prediction of hypocalcemia after thyroidectomy using parathyroid hormone: an analysis of pooled individual patient data from nine observational studies. J Am Coll Surg 205(6):748–754

    Article  PubMed  Google Scholar 

  17. Song CM, Jung JH, Ji YB, Min HJ, Ahn YH, Tae K (2014) Relationship between hypoparathyroidism and the number of parathyroid glands preserved during thyroidectomy. World J Surg Oncol. 12:200

    Article  PubMed  PubMed Central  Google Scholar 

  18. Diana M, Noll E, Diemunsch P, Dallemagne B et al (2014) Probe-based confocal laser endomicroscopy and fluorescence-based enhanced reality for real-time assessment of intestinal microcirculation in a porcine model of sigmoid ischemia. Surg Endosc 28(11):3224–3233

    Article  PubMed  Google Scholar 

  19. Alstrup T, Christensen BO, Damsgaard TE (2018) ICG angiography in immediate and delayed autologous breast reconstructions: peroperative evaluation and postoperative outcomes. J Plast Surg Hand Surg. 52(5):307–311

    Article  PubMed  Google Scholar 

  20. Karampinis I, Keese M, Jakob J, Stasiunaitis V, Gerken A, Attenberger U et al (2018) Indocyanine green tissue angiography can reduce extended bowel resections in acute mesenteric ischemia. J Gastrointest Surg. 22(6):2117–2124

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Breast, Endocrine, Metabolic and Gastrointestinal Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN, 55902, USA

    Anatoliy V. Rudin, Travis J. McKenzie, Geoffrey B. Thompson, David R. Farley & Melanie L. Lyden

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  1. Anatoliy V. Rudin
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  2. Travis J. McKenzie
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  3. Geoffrey B. Thompson
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  4. David R. Farley
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  5. Melanie L. Lyden
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Correspondence to Melanie L. Lyden.

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Rudin, A.V., McKenzie, T.J., Thompson, G.B. et al. Evaluation of Parathyroid Glands with Indocyanine Green Fluorescence Angiography After Thyroidectomy. World J Surg 43, 1538–1543 (2019). https://doi.org/10.1007/s00268-019-04909-z

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