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Intraoperative near-infrared autofluorescence imaging of parathyroid glands

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Abstract

Objective

To identify parathyroid glands intraoperatively by exposing their autofluorescence using near-infrared light.

Methods

Fluorescence imaging was carried out during minimally invasive and open parathyroid and thyroid surgery. After identification, the parathyroid glands as well as the surrounding tissue were exposed to near-infrared (NIR) light with a wavelength of 690–770 nm using a modified Karl Storz near-infrared/indocyanine green (NIR/ICG) endoscopic system. Parathyroid tissue was expected to show near-infrared autofluorescence, captured in the blue channel of the camera. Whenever possible the visual identification of parathyroid tissue was confirmed histologically.

Results

In preliminary investigations, using the original NIR/ICG endoscopic system we noticed considerable interference of light in the blue channel overlying the autofluorescence. Therefore, we modified the light source by interposing additional filters. In a second series, we investigated 35 parathyroid glands from 25 patients. Twenty-seven glands were identified correctly based on NIR autofluorescence. Regarding the extent of autofluorescence, there were no noticeable differences between parathyroid adenomas, hyperplasia and normal parathyroid glands. In contrast, thyroid tissue, lymph nodes and adipose tissue revealed no substantial autofluorescence.

Conclusion

Parathyroid tissue is characterized by showing autofluorescence in the near-infrared spectrum. This effect can be used to distinguish parathyroid glands from other cervical tissue entities.

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Authors and Affiliations

  1. Department of Surgery, Ludwig Maximilians University Munich, Innenstadt Medical Campus, Nussbaumstrasse 20, 80336, Munich, Germany

    Roland Ladurner, Sandra Sommerey, Nora Al Arabi & Klaus K. J. Hallfeldt

  2. Laser-Research Laboratory, LIFE-Center, Ludwig Maximilians University Munich, Grosshadern Medical Campus, Feodor-Lynen-Str. 19, 81377, Munich, Germany

    Herbert Stepp

  3. Department of Obstetrics and Gynecology, Ludwig Maximilians University Munich, Grosshadern Medical Campus, Marchioninistr. 15, 81377, Munich, Germany

    Julia K. S. Gallwas

Authors
  1. Roland Ladurner
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  2. Sandra Sommerey
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  3. Nora Al Arabi
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  4. Klaus K. J. Hallfeldt
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  5. Herbert Stepp
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  6. Julia K. S. Gallwas
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Corresponding author

Correspondence to Klaus K. J. Hallfeldt.

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Disclosure

Karl Storz GmbH & Co. KG provided an endoscopic NIR/ICG system free of charge to Dr. Ladurner and Dr. Hallfeldt and assisted in modifying the system. Drs. Sommerey, Al Arabi, Stepp and Gallwas have no conflicts of interest or financial ties to disclose.

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Ladurner, R., Sommerey, S., Arabi, N.A. et al. Intraoperative near-infrared autofluorescence imaging of parathyroid glands. Surg Endosc 31, 3140–3145 (2017). https://doi.org/10.1007/s00464-016-5338-3

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  • DOI: https://doi.org/10.1007/s00464-016-5338-3

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