Theodosios S Papavramidis1,2, Angeliki Chorti1, George Tzikos1, Panagiotis Anagnostis3, Pantelis Pantelidis1, Ioannis Pliakos1,2, Stavros Panidis1,2, Maria Papaioannou4, Sohail Bakkar5, Ethem Unal6, Antonios Michalopoulos1. 1. 1st Propedeutic Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece. 2. Department of Minimal Invasive Endocrine Surgery, Interbalkan Medical Center, Thessaloniki, Greece. 3. 1st Propedeutic Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece. pan.anagnostis@gmail.com. 4. Laboratory of Biological Chemistry, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece. 5. Faculty of Medicine, Department of Surgery, Hashemite University, Zarqa, Jordan. 6. Department of General Surgery, Umraniye Education and Research Hospital, Health Sciences University-Medical Faculty, Istanbul, Turkey.
Abstract
PURPOSE:Intraoperative imaging of parathyroid glands (PGs) has been developed in order to reduce the risk of unintentional parathyroidectomy during total thyroidectomy. This novel modality is based on their intrinsic characteristic of autofluorescence (AF) after near-infrared light exposure. The aim of this study was to assess the effect of this method on the risk of unintentional PG excision (total or partial) during total thyroidectomy. METHODS: This was a single-blind, randomized-controlled trial including adult patients who underwent scheduled total thyroidectomy between December 2019 and March 2020. These patients were randomly allocated to two groups: one in which near-infrared autofluorescence imaging (NIRAF) was applied (NIR group) and one without NIRAF (NONIR group). Hormonal and biochemical assessment was performed pre- and 24-h postoperatively. AF findings and the number of PGs autotransplanted were recorded. RESULTS:One-hundred and eighty patients were eligible. Unintentional (total or partial) PG excision rates during total thyroidectomy in the NONIR (n = 90) and NIR (n = 90) groups were 28.9% [95% confidence interval (CI) 19.8-39.4%] and 14.4% (95% CI 7.7-22.1%), respectively (p = 0.02). Furthermore, NIR reduced the risk of parathyroid tissue presence in the specimen sent for pathology (relative risk 0.51, 95% CI 0.28-0.92; p = 0.02). However, the number of PGs identified by NIR could not predict the risk of postoperative hypoparthyroidism. CONCLUSIONS: NIRAF imaging during total thyroidectomy led to a significant reduction in PG excision rates. However, this modality did not result in the reduction of postoperative hypoparathyroidism or hypocalcemia risk.
RCT Entities:
PURPOSE: Intraoperative imaging of parathyroid glands (PGs) has been developed in order to reduce the risk of unintentional parathyroidectomy during total thyroidectomy. This novel modality is based on their intrinsic characteristic of autofluorescence (AF) after near-infrared light exposure. The aim of this study was to assess the effect of this method on the risk of unintentional PG excision (total or partial) during total thyroidectomy. METHODS: This was a single-blind, randomized-controlled trial including adult patients who underwent scheduled total thyroidectomy between December 2019 and March 2020. These patients were randomly allocated to two groups: one in which near-infrared autofluorescence imaging (NIRAF) was applied (NIR group) and one without NIRAF (NONIR group). Hormonal and biochemical assessment was performed pre- and 24-h postoperatively. AF findings and the number of PGs autotransplanted were recorded. RESULTS: One-hundred and eighty patients were eligible. Unintentional (total or partial) PG excision rates during total thyroidectomy in the NONIR (n = 90) and NIR (n = 90) groups were 28.9% [95% confidence interval (CI) 19.8-39.4%] and 14.4% (95% CI 7.7-22.1%), respectively (p = 0.02). Furthermore, NIR reduced the risk of parathyroid tissue presence in the specimen sent for pathology (relative risk 0.51, 95% CI 0.28-0.92; p = 0.02). However, the number of PGs identified by NIR could not predict the risk of postoperative hypoparthyroidism. CONCLUSIONS: NIRAF imaging during total thyroidectomy led to a significant reduction in PG excision rates. However, this modality did not result in the reduction of postoperative hypoparathyroidism or hypocalcemia risk.
Entities:
Keywords:
Autofluorescence; Parathyroid glands; Total thyroidectomy; Unintentional parathyroidectomy
Authors: Emmanuel A Mannoh; Giju Thomas; Naira Baregamian; Sarah L Rohde; Carmen C Solórzano; Anita Mahadevan-Jansen Journal: Thyroid Date: 2021-08-18 Impact factor: 6.506
Authors: Eline A Feitsma; Hugo M Schouw; Milou E Noltes; Wido Heeman; Wendy Kelder; Gooitzen M van Dam; Schelto Kruijff Journal: Life (Basel) Date: 2022-03-08