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01-06-2017 | Original Scientific Report

Intraoperative Identification of the Parathyroid Gland with a Fluorescence Detection System

Authors: Yoshiaki Shinden, Akihiro Nakajo, Hideo Arima, Kiyonori Tanoue, Munetsugu Hirata, Yuko Kijima, Kosei Maemura, Shoji Natsugoe

Published in: World Journal of Surgery | Issue 6/2017

Abstract

Background

Intraoperative identification of the difficult-to-spot parathyroid gland is critical during surgery for thyroid and parathyroid disease. Recently, intrinsic fluorescence of the parathyroid gland was identified, and a new method was developed for intraoperative detection of the parathyroid with an original fluorescent detection apparatus. Here, we describe a method for intraoperative detection of the parathyroid using a ready-made photodynamic eye (PDE) system without any fluorescent dye or contrast agents.

Methods

Seventeen patients who underwent surgical treatment for thyroid or parathyroid disease at Kagoshima University Hospital were enrolled in this study. Intrinsic fluorescence of various tissues was detected with the PDE system. Intraoperative in vivo and ex vivo intrinsic fluorescence of the parathyroid, thyroid, lymph nodes and fat tissues was measured and analyzed.

Results

The parathyroid gland had a significantly higher fluorescence intensity than the other tissues, including the thyroid glands, lymph nodes and fat tissues, and we could identify them during surgery using the fluorescence-guided method. Our method could be applicable for two intraoperative clinical procedures: ex vivo tissue identification of parathyroid tissue and in vivo identification of the location of the parathyroid gland, including ectopic glands.

Conclusion

The PDE system may be an easy and highly feasible method to identify the parathyroid gland during surgery.

Christou N, Mathonnet M (2013) Complications after total thyroidectomy. J Visc Surg 150:249–256CrossRefPubMed

Kaplan EL, Yashiro T, Salti G (1992) Primary hyperparathyroidism in the 1990s. Ann Surg 215(4):300–317CrossRefPubMedPubMedCentral

Sosa JA, Bowman HM, Tielsch JM et al (1998) The importance of surgeon experience for clinical and economic outcomes from thyroidectomy. Ann Surg 228(3):320–330CrossRefPubMedPubMedCentral

Erbil Y, Barbaros U, Ozbey N et al (2009) Risk factors of incidental parathyroidectomy after thyroidectomy for benign thyroid disorders. Int J Surg 7:58–61CrossRefPubMed

Zarebczan B, Chen H (2011) Influence of surgical volume on operative failures for hyperparathyroidism. Adv Surg 45:237–248CrossRefPubMedPubMedCentral

Westra WH, Pritchett DD, Udelsman R (1998) Intraoperative confirmation of parathyroid tissue during parathyroid exploration: a retrospective evaluation of the frozen section. Am J Surg Pathol 22(5):538–544CrossRefPubMed

Perrier ND, Ituarte P, Kikuchi S et al (2000) Intraoperative parathyroid aspiration and parathyroid hormone assay as an alternative to frozen section for tissue identification. World J Surg 24:1319–1322CrossRefPubMed

Iacobone M, Scarpa M, Lumachi F et al (2005) Are frozen sections useful and cost-effective in the era of intraoperative qPTH assays? Surgery 138(6):1159–1165CrossRefPubMed

Paras C, Keller M, White L et al (2011) Near-infrared autofluorescence for the detection of parathyroid glands. J Biomed Opt 16(6):067012-1–067012-4CrossRef

10.

McWade MA, Paras C, White LM et al (2013) A novel optical approach to intraoperative detection of parathyroid glands. Surgery 154(6):1371–1377CrossRefPubMedPubMedCentral

11.

McWade MA, Paras C, White LM et al (2014) Label-free intraoperative parathyroid localization with near-infrared autofluorescence imaging. J Clin Endocrinol Metab 99(12):4574–4580CrossRefPubMedPubMedCentral

12.

McWade MA, Sanders ME, Broome JT et al (2016) Establishing the clinical utility of autofluorescence spectroscopy for parathyroid detection. Surgery 159:193–202CrossRefPubMed

13.

Yokoyama J, Ito S, Ohba S et al (2011) A novel approach to translymphatic chemotherapy targeting sentinel lymph nodes of patients with oral cancer using intra-arterial chemotherapy—preliminary study. Head Neck Oncol. doi:10.1186/1758-3284-3-42 PubMedPubMedCentral

14.

Miyashiro I, Miyoshi N, Hiratsuka M et al (2008) Detection of sentinel node in gastric cancer surgery by indocyanine green fluorescence imaging: comparison with infrared imaging. Ann Surg Oncol 15(6):1640–1643CrossRefPubMed

15.

Kitai T, Inomoto T, Miwa M et al (2005) Fluorescence navigation with indocyanine green for defecting sentinel lymph nodes in breast cancer. Breast Cancer 12(3):211–215CrossRefPubMed

16.

Ishizawa T, Tamura S, Masuda K et al (2009) Intraoperative fluorescent cholangiography using indocyanine green: a biliary road map for safe surgery. J Am Coll Surg 208(1):e1–e4CrossRefPubMed

17.

Kai K, Satoh S, Watanabe T et al (2010) Evaluation of cholecystic venous flow using indocyanine green fluorescence angiography. J Hepatobiliary Pancreat Sci 17:147–151CrossRefPubMed

18.

Desmettre T, Devoisselle JM, Mordon S (2000) Fluorescence properties and metabolic features of indocyanine green (ICG) as related to angiography. Surv Ophthalmol 45(1):15–27CrossRefPubMed

19.

Kusano M, Kokudo N, Toi M et al (2016) ICG fluorescence imaging and navigation surgery. Springer, Tokyo, pp 21–27CrossRef

20.

Japanese Society of Thyroid Surgery (2015) General rules for the description of thyroid cancer. Kanehara & Co. Ltd, Tokyo

21.

Funahashi H, Yasuyuki S, Imai T et al (1993) Our technique of parathyroid autotransplantation in operation for papillary thyroid carcinoma. Surgery 114:92–96PubMed

22.

Kikumori T, Imai T, Tanaka Y et al (1999) Parathyroid transplantation with total thyroidectomy for thyroid carcinoma: long-term follow up grafted parathyroid function. Surgery 125:504–508CrossRefPubMed

23.

Patel HP, Chadwick DR, Harrison BJ et al (2012) Systematic review of intravenous methylene blue in parathyroid surgery. Br J Surg 99:1345–1351CrossRefPubMed

24.

Tummers QRJG, Schepers A, Hamming JF et al (2015) Intraoperative guidance in parathyroid surgery using near-infrared fluorescence imaging and low-dose methylene blue. Surgery 158:1323–1330CrossRefPubMedPubMedCentral

Title: Intraoperative Identification of the Parathyroid Gland with a Fluorescence Detection System
Authors: Yoshiaki Shinden
Akihiro Nakajo
Hideo Arima
Kiyonori Tanoue
Munetsugu Hirata
Yuko Kijima
Kosei Maemura
Shoji Natsugoe
Publication date: 01-06-2017
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 6/2017
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-017-3903-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Intraoperative Identification of the Parathyroid Gland with a Fluorescence Detection System

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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