Sung Won Kim1, Seo Hyun Song1, Hyoung Shin Lee1, Woong Jae Noh1, Chulho Oak1, Yeh-Chan Ahn1, Kang Dae Lee1. 1. Department of Otolaryngology-Head and Neck Surgery (S.W.K., H.S.L., W.J.N., K.D.L.), Kosin University College of Medicine, and Innovative Biomedical Technology Research Center (S.W.K., S.H.S., H.S.L., W.J.N., C.O., Y.-C.A., K.D.L.), College of Medicine, Kosin University, 49267 Busan, South Korea; Department of Internal Medicine (C.O.), Kosin University College of Medicine, 49267 Busan, South Korea; and Department of Biomedical Engineering and Center for Marine-Integrated Biomedical Technology (S.H.S., Y.-C.A.), Pukyong National University, 48513 Busan, South Korea.
Abstract
CONTEXT: This biomedical investigation is valuable for identification and localization of parathyroid glands during thyroidectomy, which can provide an intraoperative real-time visual guidance. OBJECTIVE: The objective of the study was to investigate the feasibility of real-time autofluorescence imaging of the parathyroid glands without exogenous contrast dye for their localization and demonstration of relation to the background tissues. SETTING: This research was undertaken at Kosin University Gospel Hospital. METHODS: Sixteen normal parathyroid glands from eight patients with papillary thyroid carcinoma were enrolled. Photo images of the surgical field including the parathyroid and background tissues were taken with a digital camera, 780 nm light-emitting diode to excite the parathyroid, and infrared illuminator to visualize the entire neck. The area-averaged autofluorescence intensity of parathyroid over the area-averaged fluorescence intensity of background tissues was measured. MAIN OUTCOME MEASURE: The location of the parathyroid gland was verified with a single image. RESULTS: The area-averaged autofluorescence intensity of parathyroid over the area-averaged fluorescence intensity of background tissues for all parathyroid glands was higher than 1, with a minimum of 1.95 and a maximum of 5.20 (average 2.76, SD 0.79). By our technique, all 16 parathyroid glands were detected (positive predictive value of 100%), and the entire surgical field including the parathyroid and background tissues was visualized as well. The parathyroid glands that were exposed or even covered by connective tissues or blood vessels could be detected with strong emission. CONCLUSIONS: This method showed the precise localization of the parathyroid glands and demonstrated their relation to background tissue. We believe that this simple, nonexogenous dye technique of anatomical guidance can aid surgeons to preserve parathyroid glands during thyroidectomy.
CONTEXT: This biomedical investigation is valuable for identification and localization of parathyroid glands during thyroidectomy, which can provide an intraoperative real-time visual guidance. OBJECTIVE: The objective of the study was to investigate the feasibility of real-time autofluorescence imaging of the parathyroid glands without exogenous contrast dye for their localization and demonstration of relation to the background tissues. SETTING: This research was undertaken at Kosin University Gospel Hospital. METHODS: Sixteen normal parathyroid glands from eight patients with papillary thyroid carcinoma were enrolled. Photo images of the surgical field including the parathyroid and background tissues were taken with a digital camera, 780 nm light-emitting diode to excite the parathyroid, and infrared illuminator to visualize the entire neck. The area-averaged autofluorescence intensity of parathyroid over the area-averaged fluorescence intensity of background tissues was measured. MAIN OUTCOME MEASURE: The location of the parathyroid gland was verified with a single image. RESULTS: The area-averaged autofluorescence intensity of parathyroid over the area-averaged fluorescence intensity of background tissues for all parathyroid glands was higher than 1, with a minimum of 1.95 and a maximum of 5.20 (average 2.76, SD 0.79). By our technique, all 16 parathyroid glands were detected (positive predictive value of 100%), and the entire surgical field including the parathyroid and background tissues was visualized as well. The parathyroid glands that were exposed or even covered by connective tissues or blood vessels could be detected with strong emission. CONCLUSIONS: This method showed the precise localization of the parathyroid glands and demonstrated their relation to background tissue. We believe that this simple, nonexogenous dye technique of anatomical guidance can aid surgeons to preserve parathyroid glands during thyroidectomy.
Authors: Melanie A McWade; Giju Thomas; John Q Nguyen; Melinda E Sanders; Carmen C Solórzano; Anita Mahadevan-Jansen Journal: J Am Coll Surg Date: 2019-02-13 Impact factor: 6.113
Authors: Giju Thomas; Melanie A McWade; John Q Nguyen; Melinda E Sanders; James T Broome; Naira Baregamian; Carmen C Solórzano; Anita Mahadevan-Jansen Journal: Surgery Date: 2018-11-12 Impact factor: 3.982
Authors: Giju Thomas; Melanie A McWade; Constantine Paras; Emmanuel A Mannoh; Melinda E Sanders; Lisa M White; James T Broome; John E Phay; Naira Baregamian; Carmen C Solórzano; Anita Mahadevan-Jansen Journal: Thyroid Date: 2018-09-11 Impact factor: 6.568