Skip to main content

Advertisement

SpringerLink
Log in

Total thyroidectomy with intraoperative neural monitoring and near-infrared fluorescence imaging

  • How-I-Do-It articles
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Purpose

To describe our personal experience during aclassic complete thyroidectomy adopting both intraoperative neural monitoringand near-infrared autofluorescence.

Methods

In October 2021, 20 patients underwent totalthyroidectomy for benign and malignant conditions: 13 patients were affected bymultinodular goiter, 2 by Graves’ disease, and 5 by indeterminate lesions (3Tir-3B and 2 Tir-3A). For each patient, intraoperative neural monitoring of therecurrent laryngeal nerve and near-infrared autofluorescence were used.

Results

Overall, 76/80 (95.0%) parathyroid glands weredetected: 34/76 (44.7%) were identified by the surgeon during the dissection,while 42/76 (55.3%) were detected by the near-infrared camera before thesurgeon saw them with naked eye. Indocyanine green angiography was adopted inall the patients, and in 2 cases, parathyroid gland autotransplantation wasperformed since 2 parathyroid glands resulted devascularized after dissection.Operative time ranged from 113 to 201 min (mean 156 min).

Conclusion

Together with intraoperative neural monitoring,near-infrared autofluorescence is a reliable device in thyroid surgery. Furtherprospective studies are necessary to establish if the adoption ofautofluorescence may result in long-term benefit in terms of calcemia.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Rosato L, Avenia N, Bernante P et al (2004) Complications of thyroid surgery: analysis of a multicentric study on 14,934 patients operated on in Italy over 5 years. World J Surg. Published online.https://doi.org/10.1007/s00268-003-6903-1

  2. 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. https://doi.org/10.1002/bjs.9384

    Article  CAS  PubMed  Google Scholar 

  3. Chadwick DR (2017) Hypocalcaemia and permanent hypoparathyroidism after total/bilateral thyroidectomy in the BAETS Registry. Gland Surg. Published online.https://doi.org/10.21037/gs.2017.09.14

  4. Randolph GW, Dralle H (2011) Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: international standards guideline statement. Laryngoscope. Published online.https://doi.org/10.1002/lary.21119

  5. Benmiloud F, Godiris-Petit G, Gras R et al (2020) Association of autofluorescence-based detection of the parathyroid glands during total thyroidectomy with postoperative hypocalcemia risk: results of the PARAFLUO multicenter randomized clinical trial. JAMA Surg 155(2):106–112. https://doi.org/10.1001/jamasurg.2019.4613

    Article  PubMed  Google Scholar 

  6. Barbieri D, Indelicato P, Vinciguerra A et al (2020) Autofluorescence and indocyanine green in thyroid surgery: a systematic review and meta-analysis. Laryngoscope. Published online. https://doi.org/10.1002/lary.29297

  7. Lorenz K, Sekulla C, Schelle J, Schmei B, Brauckhoff M, Dralle H (2010) What are normal quantitative parameters of intraoperative neuromonitoring (IONM) in thyroid surgery? Langenbeck’s Arch Surg 395(7):901–909. https://doi.org/10.1007/s00423-010-0691-5

    Article  Google Scholar 

  8. Sinclair CF, Bumpous JM, Haugen BR et al (2016) Laryngeal examination in thyroid and parathyroid surgery: an American Head and Neck Society consensus statement: AHNS Consensus Statement. Head Neck 38(6):811–819. https://doi.org/10.1002/hed.24409

    Article  PubMed  Google Scholar 

  9. Patel KN, Yip L, Lubitz CC et al (2020) The American Association of Endocrine Surgeons Guidelines for the definitive surgical management of thyroid disease in adults. Ann Surg 271(3):e21–e93. https://doi.org/10.1097/SLA.0000000000003580

    Article  PubMed  Google Scholar 

  10. Gharib H, Papini E, Valcavi R et al (2006) American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocr Pract Off J Am Coll Endocrinol Am Assoc Clin Endocrinol 12(1):63–102. https://doi.org/10.4158/EP.12.1.63

    Article  Google Scholar 

  11. Schneider R, Randolph GW, Dionigi G et al (2018) International neural monitoring study group guideline 2018 part I: staging bilateral thyroid surgery with monitoring loss of signal. Laryngoscope 128(October):S18–S27. https://doi.org/10.1002/lary.27359

    Article  PubMed  Google Scholar 

  12. Wu CW, Dionigi G, Barczynski M et al (2018) International neuromonitoring study group guidelines 2018: Part II: optimal recurrent laryngeal nerve management for invasive thyroid cancer—incorporation of surgical, laryngeal, and neural electrophysiologic data. Laryngoscope. Published online. https://doi.org/10.1002/lary.27360

  13. Cusano NE, Rubin MR, McMahon DJ et al (2013) The effect of PTH(1-84) on quality of life in hypoparathyroidism. J Clin Endocrinol Metab. Published online. https://doi.org/10.1210/jc.2013-1239

  14. Underbjerg L, Sikjaer T, Mosekilde L, Rejnmark L (2014) Postsurgical hypoparathyroidism-risk of fractures, psychiatric diseases, cancer, cataract, and infections. J Bone Miner Res. Published online. https://doi.org/10.1002/jbmr.2273

  15. Benmiloud F, Rebaudet S, Varoquaux A, Penaranda G, Bannier M, Denizot A (2018) Impact of autofluorescence-based identification of parathyroids during total thyroidectomy on postoperative hypocalcemia: a before and after controlled study. Surg (United States) 163(1):23–30. https://doi.org/10.1016/j.surg.2017.06.022

    Article  Google Scholar 

  16. Fanaropoulou NM, Chorti A, Markakis M, Papaioannou M, Michalopoulos A, Papavramidis T (2019) The use of indocyanine green in endocrine surgery of the neck. Med (United States) 98(10). https://doi.org/10.1097/MD.0000000000014765

  17. Rudin AV, McKenzie TJ, Thompson GB, Farley DR, Lyden ML (2019) Evaluation of parathyroid glands with indocyanine green fluorescence angiography after thyroidectomy. World J Surg 43(6):1538–1543. https://doi.org/10.1007/s00268-019-04909-z

    Article  PubMed  Google Scholar 

  18. Chang YK, Lang BHH (2017) To identify or not to identify parathyroid glands during total thyroidectomy. Gland Surg 6(Suppl 1):S20–S29. https://doi.org/10.21037/gs.2017.06.13

    Article  PubMed  PubMed Central  Google Scholar 

  19. Lerchenberger M, Al Arabi N, Gallwas JKS, Stepp H, Hallfeldt KKJ, Ladurner R (2019) Intraoperative near-infrared autofluorescence and indocyanine green imaging to identify parathyroid glands: a comparison. Int J Endocrinol 2019. https://doi.org/10.1155/2019/4687951

Download references

Author information

Authors and Affiliations

  1. Division of Head and Neck department, Otorhinolaryngology unit, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Diego Barbieri, Pietro Indelicato, Alessandro Vinciguerra, Matteo Trimarchi & Mario Bussi

  2. Department of Thoracic and Endocrine Surgery, University Hospitals of Geneva, Geneva, Switzerland

    Frédéric Triponez

  3. School of Medicine, Vita-Salute San Raffaele University, Milan, Italy

    Pietro Indelicato, Alessandro Vinciguerra, Matteo Trimarchi & Mario Bussi

Authors
  1. Diego Barbieri
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Frédéric Triponez
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Pietro Indelicato
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alessandro Vinciguerra
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Matteo Trimarchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mario Bussi
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Study conception and design: Diego Barbieri, Pietro Indelicato, Mario Bussi; acquisition of data: Pietro Indelicato, Alessandro Vinciguerra; analysis and interpretation of data: Diego Barbieri, Pietro Indelicato, Alessandro Vinciguerra; drafting of manuscript: Diego Barbieri, Pietro Indelicato; critical revision: Diego Barbieri, Matteo Trimarchi, Mario Bussi.

Corresponding author

Correspondence to Diego Barbieri.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Barbieri, D., Triponez, F., Indelicato, P. et al. Total thyroidectomy with intraoperative neural monitoring and near-infrared fluorescence imaging. Langenbecks Arch Surg 406, 2879–2885 (2021). https://doi.org/10.1007/s00423-021-02228-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-021-02228-3

Keywords

Search

Navigation