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

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Abstract

Background

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.

Results

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).

Conclusion

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.

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Authors and Affiliations

  1. Hospital de Clínicas “José de San Martín”, University of Buenos Aires, Buenos Aires, Argentina

    Jorge Falco, Fernando Dip, Pablo Quadri & Martin de la Fuente

  2. Department of General Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL, 33331, USA

    Fernando Dip & Raúl J. Rosenthal

  3. National University of Rosario Santa Fe, Rosario, Argentina

    Marcos Prunello

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  1. Jorge Falco
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  2. Fernando Dip
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  3. Pablo Quadri
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  4. Martin de la Fuente
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  5. Marcos Prunello
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  6. Raúl J. Rosenthal
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Correspondence to Raúl J. Rosenthal.

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Disclosures

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.

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Falco, J., Dip, F., Quadri, P. et al. Increased identification of parathyroid glands using near infrared light during thyroid and parathyroid surgery. Surg Endosc 31, 3737–3742 (2017). https://doi.org/10.1007/s00464-017-5424-1

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  • DOI: https://doi.org/10.1007/s00464-017-5424-1

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