Top

Surgical Endoscopy

Published in:

18-09-2023 | Hypoparathyroidism | 2023 SAGES Oral

Intraoperative indocyanine green angiography for predicting postoperative hypoparathyroidism

Authors: Volodymyr V. Grubnik, Roman S. Parfentiev, Yurii V. Grubnik, Viktor V. Grubnyk

Published in: Surgical Endoscopy | Issue 12/2023

Abstract

Background

Postoperative hypocalcemia is a common complication of thyroidectomy. This problem is most often associated with accidental devascularization or excision of the parathyroid glands (PG).

Aim

Aim was to study near-infrared (NIR) fluorescent imaging with intraoperative PG indocyanine green (ICG) angiography to help identify and preserve PG during total thyroidectomy in order to avoid postoperative hypocalcemia.

Material and methods

From 2017 to 2022, a total of 92 patients underwent total thyroidectomy at Odessa Regional Hospital. Indications for surgery were multinodular goiter (n = 42), thyroid cancer (n = 43), and Graves’ disease (n = 7). By randomization all patients were divided into two groups: in the control group, 48 patients underwent standard total thyroidectomy, and in the main group, 44 patients underwent NIR-assisted total thyroidectomy with ICG angiography. Serum calcium and parathyroid hormone levels were compared between the two groups of patients in 1, 7–15 days after surgery and then 3, 6 months later.

Results

In the control group, based on a visual assessment of the PG, autotransplantation of the PG was conducted in only five cases. In the second group, autotransplantation was performed in 16 patients. The transient postoperative hypocalcemia was observed in 8 patients of the control group (16, 70%) and in the 2 patients of ICG group (4, 50%) on 5–10 postoperative days. In the first group, 2 patients at 3 months after surgery had permanent hypocalcaemia.

Conclusion

NIR fluorescent imaging with intraoperative PG ICG angiography is a safe and an easily repeatable method. This technique provides improved detecting and assessment of the perfusion of the PG. The need for autotransplantation of the PG can be determined more objectively using ICG imaging than simple visualization.

Almquist M, Hallgrimsson P, Nordenström E, Bergenfelz A (2014) Prediction of permanent hypoparathyroidism after total thyroidectomy. World J Surg 38(10):2613–2620. https://doi.org/10.1007/s00268-014-2622-zCrossRefPubMed

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.9384CrossRefPubMed

Rao SS, Rao H, Moinuddin Z, Rozario AP, Augustine T (2023) Preservation of parathyroid glands during thyroid and neck surgery. Front Endocrinol 14:1173950. https://doi.org/10.3389/fendo.2023.1173950CrossRef

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. https://doi.org/10.1002/bjs.10101CrossRefPubMed

Spartalis E, Ntokos G, Georgiou K, Zografos G, Tsourouflis G, Dimitroulis D, Nikiteas NI (2020) Intraoperative indocyanine green (ICG) angiography for the identification of the parathyroid glands: current evidence and future perspectives. In vivo (Athens, Greece) 34(1):23–32. https://doi.org/10.21873/invivo.11741CrossRefPubMed

Jin H, Dong Q, He Z, Fan J, Liao K, Cui M (2018) Application of a fluorescence imaging system with indocyanine green to protect the parathyroid gland intraoperatively and to predict postoperative parathyroidism. Adv Ther 35(12):2167–2175. https://doi.org/10.1007/s12325-018-0834-6CrossRefPubMed

van den Bos J, van Kooten L, Engelen SME, Lubbers T, Stassen LPS, Bouvy ND (2019) Feasibility of indocyanine green fluorescence imaging for intraoperative identification of parathyroid glands during thyroid surgery. Head Neck 41(2):340–348. https://doi.org/10.1002/hed.25451CrossRefPubMed

Jin H, Fan J, Yang J, Liao K, He Z, Cui M (2019) Application of indocyanine green in the parathyroid detection and protection: report of 3 cases. Am J Otolaryngol 40(2):323–330. https://doi.org/10.1016/j.amjoto.2018.11.003CrossRefPubMed

Alesina PF, Meier B, Hinrichs J, Mohmand W, Walz MK (2018) Enhanced visualization of parathyroid glands during video-assisted neck surgery. Langenbecks Arch Surg 403(3):395–401. https://doi.org/10.1007/s00423-018-1665-2CrossRefPubMed

10.

Zaidi N, Bucak E, Yazici P, Soundararajan S, Okoh A, Yigitbas H, Dural C, Berber E (2016) The feasibility of indocyanine green fluorescence imaging for identifying and assessing the perfusion of parathyroid glands during total thyroidectomy. J Surg Oncol 113(7):775–778. https://doi.org/10.1002/jso.24237CrossRefPubMed

11.

Suh YJ, Choi JY, Chai YJ, Kwon H, Woo JW, Kim SJ, Kim KH, Lee KE, Lim YT, Youn YK (2015) Indocyanine green as a near-infrared fluorescent agent for identifying parathyroid glands during thyroid surgery in dogs. Surg Endosc 29(9):2811–2817. https://doi.org/10.1007/s00464-014-3971-2CrossRefPubMed

12.

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.2017.06.13CrossRefPubMedPubMedCentral

13.

Cui Q, Li Z, Kong D, Wang K, Wu G (2016) A prospective cohort study of novel functional types of parathyroid glands in thyroidectomy: In situ preservation or auto-transplantation? Medicine 95(52):e5810. https://doi.org/10.1097/MD.0000000000005810CrossRefPubMed

14.

Reeve TS, Curtin A, Fingleton L, Kennedy P, Mackie W, Porter T, Simons D, Townend D, Delbridge L (1994) Can total thyroidectomy be performed as safely by general surgeons in provincial centers as by surgeons in specialized endocrine surgical units? Making the case for surgical training. Arch Surg (Chicago, IL: 1960) 129(8):834–836. https://doi.org/10.1001/archsurg.1994.01420320060011CrossRef

15.

Algethami RF, Algarni F, Fallatah S, Almehmadi RA, Aljuaid H, Alsalem AS, Mahfouz MEM, Alosaimi M (2022) Prevalence and risk factors for hypoparathyroidism following total thyroidectomy in Taif City. Cureus 14(12):e32460. https://doi.org/10.7759/cureus.32460CrossRefPubMed

16.

Zhu JQ, Tian W, Xu ZG, Jiang KW, Sun H, Wang P et al (2015) The expert consensus of parathyroid glands protection during thyroidectomy. Chin J Pract Surg 35:731–736. https://doi.org/10.3978/j.issn.2305-5839.2015.08.20CrossRef

17.

Lorente-Poch L, Sancho J, Muñoz JL, Gallego-Otaegui L, Martínez-Ruiz C, Sitges-Serra A (2017) Failure of fragmented parathyroid gland autotransplantation to prevent permanent hypoparathyroidism after total thyroidectomy. Langenbecks Arch Surg 402(2):281–287. https://doi.org/10.1007/s00423-016-1548-3CrossRefPubMed

18.

Tartaglia F, Blasi S, Giuliani A, Merola R, Livadoti G, Krizzuk D, Tortorelli G, Tromba L (2016) Parathyroid autotransplantation during total thyroidectomy. Results of a retrospective study. Int J Surg (London England) 28(Suppl 1):S79–S83. https://doi.org/10.1016/j.ijsu.2015.05.059CrossRef

19.

Promberger R, Ott J, Kober F, Mikola B, Karik M, Freissmuth M, Hermann M (2010) Intra- and postoperative parathyroid hormone-kinetics do not advocate for autotransplantation of discolored parathyroid glands during thyroidectomy. Thyroid 20(12):1371–1375. https://doi.org/10.1089/thy.2010.0157CrossRefPubMed

20.

Kuhel WI, Carew JF (1999) Parathyroid biopsy to facilitate the preservation of functional parathyroid tissue during thyroidectomy. Head Neck 21(5):442–446. https://doi.org/10.1002/(sici)1097-0347(199908)21:5%3c442::aid-hed10%3e3.0.co;2-zCrossRefPubMed

21.

Delbridge L (2003) Total thyroidectomy: the evolution of surgical technique. ANZ J Surg 73(9):761–768. https://doi.org/10.1046/j.1445-2197.2003.02756.xCrossRefPubMed

22.

Promberger R, Ott J, Bures C, Kober F, Freissmuth M, Seemann R, Hermann M (2014) Can a surgeon predict the risk of postoperative hypoparathyroidism during thyroid surgery? A prospective study on self-assessment by experts. Am J Surg 208(1):13–20. https://doi.org/10.1016/j.amjsurg.2013.11.007CrossRefPubMed

23.

Fanaropoulou NM, Chorti A, Markakis M, Papaioannou M, Michalopoulos A, Papavramidis T (2019) The use of Indocyanine green in endocrine surgery of the neck: a systematic review. Medicine 98(10):e14765. https://doi.org/10.1097/MD.0000000000014765CrossRefPubMedPubMedCentral

24.

Sanchez EQ, Chinnakotla S, Khan T, Nikitin D, Vasani S, Randall HB, McKenna GJ, Ruiz R, Onaca N, Levy MF, Goldstein RM, Docherty JC, Hurd DK, Klintmalm GB (2008) Intraoperative imaging of pancreas transplant allografts using indocyanine green with laser fluorescence. Proceedings (Baylor Univ Med Center) 21(3):258–260. https://doi.org/10.1080/08998280.2008.11928406CrossRefPubMedCentral

25.

Tobis S, Knopf JK, Silvers CR, Marshall J, Cardin A, Wood RW, Reeder JE, Erturk E, Madeb R, Yao J, Singer EA, Rashid H, Wu G, Messing E, Golijanin D (2012) Near infrared fluorescence imaging after intravenous indocyanine green: initial clinical experience with open partial nephrectomy for renal cortical tumors. Urology 79(4):958–964. https://doi.org/10.1016/j.urology.2011.10.016CrossRef

26.

DeLong JC, Ward EP, Lwin TM, Brumund KT, Kelly KJ, Horgan S, Bouvet M (2018) Indocyanine green fluorescence-guided parathyroidectomy for primary hyperparathyroidism. Surgery 163(2):388–392. https://doi.org/10.1016/j.surg.2017.08.018CrossRefPubMed

27.

Boni L, David G, Mangano A, Dionigi G, Rausei S, Spampatti S, Cassinotti E, Fingerhut A (2015) Clinical applications of indocyanine green (ICG) enhanced fluorescence in laparoscopic surgery. Surg Endosc 29(7):2046–2055. https://doi.org/10.1007/s00464-014-3895-xCrossRefPubMed

28.

Perry D, Bharara M, Armstrong DG, Mills J (2012) Intraoperative fluorescence vascular angiography: during tibial bypass. J Diabetes Sci Technol 6(1):204–208. https://doi.org/10.1177/193229681200600125CrossRefPubMedPubMedCentral

Title: Intraoperative indocyanine green angiography for predicting postoperative hypoparathyroidism
Authors: Volodymyr V. Grubnik
Roman S. Parfentiev
Yurii V. Grubnik
Viktor V. Grubnyk
Publication date: 18-09-2023
Publisher: Springer US
Keywords: Hypoparathyroidism
Thyroidectomy
Thyroidectomy
Angiography
Hypocalcemia
Published in: Surgical Endoscopy / Issue 12/2023
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-023-10466-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Intraoperative indocyanine green angiography for predicting postoperative hypoparathyroidism

Abstract

Background

Aim

Material and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Aim

Material and methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 12/2023

What is the educational value and clinical utility of artificial intelligence for intraoperative and postoperative video analysis? A survey of surgeons and trainees

Intraoperative distensibility measurement in POEM for achalasia: impact on patient outcome and associations with other outcome variables at 1-year follow-up

Characterization of the robotic surgery experience in minimally invasive surgery fellowships from 2010 to 2021

Radicality and safety of mediastinal lymphadenectomy in lung resection: a comparative analysis of uniportal thoracoscopic, multiportal thoracoscopic, and thoracotomy approaches

Laparoscopic anatomical left hemihepatectomy guided by middle hepatic vein in the treatment of left hepatolithiasis with a history of upper abdominal surgery

Safety and efficacy of laparoscopic transperitoneal versus retroperitoneal resection for benign retroperitoneal tumors: a retrospective cohort study