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Intraoperative localization of the parathyroid glands with indocyanine green and Firefly(R) technology during BABA robotic thyroidectomy

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Abstract

Background

It is unclear whether near-infrared (NIR) light-induced indocyanine green (ICG) fluorescence can effectively identify, and thus permit the preservation of, parathyroid glands in bilateral axillo-breast approach (BABA) robotic thyroidectomy. This case–control study with a prospectively recruited consecutive series and a retrospectively selected control group assessed the usefulness of ICG with Firefly(R) technology to identify the parathyroid glands intraoperatively during BABA robotic thyroidectomy.

Methods

All consecutive patients (N = 22) who were scheduled to undergo BABA robotic thyroidectomy for papillary thyroid carcinoma in December 2013–August 2015 and met the study eligibility criteria were recruited prospectively. ICG fluorescence was used with the Firefly system (NIR illuminator: 805 nm; filter: 825 nm) integrated in the da Vinci Si robot system to identify the lower parathyroid glands. Parathyroid hormone levels were recorded on postoperative days 0, 1, 2, and 14. Propensity score matching was used to identify an age-, gender-, tumor size-, and operation type-matched group of control patients who underwent BABA robotic thyroidectomy without the Firefly system. The two groups were compared in terms of parathyroid-related outcomes.

Results

ICG fluorescence-mediated identification of the parathyroid and thyroid glands required on average (range) 203 ± 89 (125–331) and 207 ± 112 (130–356) s, respectively. The mean (range) fluorescence duration in these glands was 20.8 ± 6.0 (16.6–35.8) and 20.1 ± 7.3 (15.5–33.8) min, respectively. The ICG group had a significantly lower rate of incidental parathyroidectomy than the control group (0 vs. 15.9%, P = 0.048).

Conclusions

ICG with NIR light may feasibly and safely identify the parathyroid glands in BABA robotic thyroidectomy.

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Acknowledgements

This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT and Future Planning, Republic of Korea (Grant number: 2015R1C1A1A01055464).

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    Authors and Affiliations

    1. Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong Bundang-gu, Seongnam-si, Gyeonggi-do, Korea

      Hyeong Won Yu, Joon Woo Chung, Joon-Hyop Lee & June Young Choi

    2. Department of Surgery, Seoul National University Hospital and College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, Korea

      Jin Wook Yi, Ra-Yeong Song, Hyungju Kwon, Su-jin Kim & Kyu Eun Lee

    3. Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea

      Hyeong Won Yu, Joon Woo Chung, Jin Wook Yi, Ra-Yeong Song, Joon-Hyop Lee, Hyungju Kwon, Su-jin Kim, June Young Choi & Kyu Eun Lee

    4. Department of Surgery, Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, Korea

      Young Jun Chai

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    Correspondence to June Young Choi.

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    Hyeong Won Yu, Joon Woo Chung, Jin Wook Yi, Ra-Yeong Song, Joon-Hyop Lee, Hyungju Kwon, Su-jin Kim, Young Jun Chai, June Young Choi, and Kyu Eun Lee have no conflicts of interest or financial ties to disclosure.

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    Hyeong Won Yu and Joon Woo Chung have contributed equally to this article as co-first authors.

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    Yu, H.W., Chung, J.W., Yi, J.W. et al. Intraoperative localization of the parathyroid glands with indocyanine green and Firefly(R) technology during BABA robotic thyroidectomy. Surg Endosc 31, 3020–3027 (2017). https://doi.org/10.1007/s00464-016-5330-y

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