The effect of probe-based near infrared autofluorescence technology in the identification and functional protection of parathyroid gland during endoscopic total thyroidectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YIN Tingjie ^1,2 , PAN Bin ^1,2 , YIN Supeng ² , SUN Yiceng ² , HOU Shaodong ² ,  ZHANG Fan ^1,2

1. Graduate School of Medicine, Chongqing Medical University, Chongqing 40016, P. R. China;
2. Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing 401121, P. R. China;

Corresponding author：

ZHANG Fan, Email: zhangfancgh@163.com

Keywords：

probe-based parathyroid detection technology; autofluorescence; parathyroid gland; hypoparathyroidism; total thyroidectomy

DOI：

10.7507/1007-9424.202404088

Video：

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Objective To investigate the effectiveness of probe-based near infrared autofluorescence (AF) technology in the identification and functional protection of parathyroid gland (PG) during endoscopic total thyroidectomy. Methods We retrospectively collected the clinical data of 160 patients who underwent total thyroidectomy with bilateral central compartment lymph node dissection due to papillary thyroid carcinoma in Chongqing General Hospital from 1 July 2023 to 31 January 2024. Among them, 80 patients who used probe-based near infrared AF technology to identify the PGs were categorized as the AF group, 80 patients who used naked eye (NE) to identify the PGs were categorized as the NE group. The number of PGs identified, inadvertently removed, preserved in situ and autotransplanted, the incidence of postoperative hypoparathyroidism, and operative time were compared between the two groups. Results The incidence of transient hypoparathyroidism was significantly lower in the AF group than that of the NE group [21.25% (17/80) vs. 43.75% (35/80), χ²=9.231, P=0.002], with no cases of permanent hypoparathyroidism in either group. The AF group had significantly more PGs identified and preserved in situ than the NE group (P<0.05) , but had significantly fewer PGs inadvertently removed and autotransplanted than the NE group (P<0.05). The AF group identified the first PG earlier than the NE group (4 min vs. 5 min, P<0.001. But there was no statistically difference in the operative time between the two groups (90 min vs. 94 min, P=0.052). Conclusion The probe-based near infrared AF technology can help surgeons better identify and protect PGs during surgery, reducing the incidence of postoperative transient hypoparathyroidism.

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2.	Christou N, Mathonnet M. Complications after total thyroidectomy. J Visc Surg, 2013, 150(4): 249-256.
3.	Sanabria A, Kowalski LP, Tartaglia F. Inferior thyroid artery ligation increases hypocalcemia after thyroidectomy: a meta-analysis. Laryngoscope, 2018, 128(2): 534-541.
4.	Dip F, Falco J, Verna S, et al. Randomized controlled trial comparing white light with near-infrared autofluorescence for parathyroid gland identification during total thyroidectomy. J Am Coll Surg, 2019, 228(5): 744-751.
5.	Benmiloud F, Rebaudet S, Varoquaux A, et al. Impact of autofluorescence-based identification of parathyroids during total thyroidectomy on postoperative hypocalcemia: a before and after controlled study. Surgery, 2018, 163(1): 23-30.
6.	Wang B, Zhu CR, Liu H, et al. The ability of near-infrared autofluorescence to protect parathyroid gland function during thyroid surgery: a meta-analysis. Front Endocrinol (Lausanne), 2021, 12: 714691. doi: 10.3389/fendo.2021.714691.
7.	Falco J, Dip F, Quadri P, et al. Cutting edge in thyroid surgery: autofluorescence of parathyroid glands. J Am Coll Surg, 2016, 223(2): 374-380.
8.	Benmiloud F, Godiris-Petit G, Gras R, et al. Association of autofluorescence-based detection of the parathyroid glands during total thyroidectomy with postoperative hypocalcemia risk: results of the PARAFLUO multicenter randomized clinical trial. JAMA Surg, 2020, 155(2): 106-112.
9.	Tjahjono R, Nguyen K, Phung D, et al. Methods of identification of parathyroid glands in thyroid surgery: a literature review. ANZ J Surg, 2021, 91(9): 1711-1716.
10.	Solórzano CC, Thomas G, Baregamian N, et al. Detecting the near infrared autofluorescence of the human parathyroid: hype or opportunity? Ann Surg, 2020, 272(6): 973-985.
11.	中国医师协会外科医师分会甲状腺外科医师委员会. 甲状腺手术中甲状旁腺保护专家共识. 中国实用外科杂志, 2015, 35(7): 731-736.
12.	Hauch A, Al-Qurayshi Z, Randolph G, et al. Total thyroidectomy is associated with increased risk of complications for low- and high-volume surgeons. Ann Surg Oncol, 2014, 21(12): 3844-3852.
13.	Orloff LA, Wiseman SM, Bernet VJ, et al. American Thyroid Association Statement on postoperative hypoparathyroidism: diagnosis, prevention, and management in adults. Thyroid, 2018, 28(7): 830-841.
14.	Wang B, Zhu CR, Liu H, et al. The accuracy of near infrared autofluorescence in identifying parathyroid gland during thyroid and parathyroid surgery: a meta-analysis. Front Endocrinol (Lausanne), 2021, 12: 701253. doi: 10.3389/fendo.2021.701253.
15.	Solórzano CC, Thomas G, Berber E, et al. Current state of intraoperative use of near infrared fluorescence for parathyroid identification and preservation. Surgery, 2021, 169(4): 868-878.
16.	杨晓晴, 王正寨, 林溪源, 等. 自体荧光在甲状旁腺研究中的进展. 中国普外基础与临床杂志, 2023, 30(2): 236-241.
17.	McWade MA, Paras C, White LM, et al. A novel optical approach to intraoperative detection of parathyroid glands. Surgery, 2013, 154(6): 1371-1377.
18.	McWade MA, Sanders ME, Broome JT, et al. Establishing the clinical utility of autofluorescence spectroscopy for parathyroid detection. Surgery, 2016, 159(1): 193-202.
19.	Paras C, Keller M, White L, et al. Near-infrared autofluorescence for the detection of parathyroid glands. J Biomed Opt, 2011, 16(6): 067012. doi: 10.1117/1.3583571.
20.	McWade MA, Paras C, White LM, et al. Label-free intraoperative parathyroid localization with near-infrared autofluorescence imaging. J Clin Endocrinol Metab, 2014, 99(12): 4574-4580.
21.	Thomas G, McWade MA, Paras C, et al. Developing a clinical prototype to guide surgeons for intraoperative label-free identification of parathyroid glands in real time. Thyroid, 2018, 28(11): 1517-1531.
22.	Kiernan CM, Thomas G, Patel A, et al. Does the use of probe-based near-infrared autofluorescence parathyroid detection benefit parathyroidectomy?: a randomized single-center clinical trial. Ann Surg, 2023, 278(4): 549-558.
23.	万政, 徐波, 杨晓冬, 等. 基于探针式甲状旁腺近红外自体荧光显像技术在甲状腺手术中的应用. 中华内分泌外科杂志, 2023, 17(4): 404-409.

1. Qi J, Li M, Wang L, et al. National and subnational trends in cancer burden in China, 2005–20: an analysis of national mortality surveillance data. Lancet Public Health, 2023, 8(12): e943-e955.
2. Christou N, Mathonnet M. Complications after total thyroidectomy. J Visc Surg, 2013, 150(4): 249-256.
3. Sanabria A, Kowalski LP, Tartaglia F. Inferior thyroid artery ligation increases hypocalcemia after thyroidectomy: a meta-analysis. Laryngoscope, 2018, 128(2): 534-541.
4. Dip F, Falco J, Verna S, et al. Randomized controlled trial comparing white light with near-infrared autofluorescence for parathyroid gland identification during total thyroidectomy. J Am Coll Surg, 2019, 228(5): 744-751.
5. Benmiloud F, Rebaudet S, Varoquaux A, et al. Impact of autofluorescence-based identification of parathyroids during total thyroidectomy on postoperative hypocalcemia: a before and after controlled study. Surgery, 2018, 163(1): 23-30.
6. Wang B, Zhu CR, Liu H, et al. The ability of near-infrared autofluorescence to protect parathyroid gland function during thyroid surgery: a meta-analysis. Front Endocrinol (Lausanne), 2021, 12: 714691. doi: 10.3389/fendo.2021.714691.
7. Falco J, Dip F, Quadri P, et al. Cutting edge in thyroid surgery: autofluorescence of parathyroid glands. J Am Coll Surg, 2016, 223(2): 374-380.
8. Benmiloud F, Godiris-Petit G, Gras R, et al. Association of autofluorescence-based detection of the parathyroid glands during total thyroidectomy with postoperative hypocalcemia risk: results of the PARAFLUO multicenter randomized clinical trial. JAMA Surg, 2020, 155(2): 106-112.
9. Tjahjono R, Nguyen K, Phung D, et al. Methods of identification of parathyroid glands in thyroid surgery: a literature review. ANZ J Surg, 2021, 91(9): 1711-1716.
10. Solórzano CC, Thomas G, Baregamian N, et al. Detecting the near infrared autofluorescence of the human parathyroid: hype or opportunity? Ann Surg, 2020, 272(6): 973-985.
11. 中国医师协会外科医师分会甲状腺外科医师委员会. 甲状腺手术中甲状旁腺保护专家共识. 中国实用外科杂志, 2015, 35(7): 731-736.
12. Hauch A, Al-Qurayshi Z, Randolph G, et al. Total thyroidectomy is associated with increased risk of complications for low- and high-volume surgeons. Ann Surg Oncol, 2014, 21(12): 3844-3852.
13. Orloff LA, Wiseman SM, Bernet VJ, et al. American Thyroid Association Statement on postoperative hypoparathyroidism: diagnosis, prevention, and management in adults. Thyroid, 2018, 28(7): 830-841.
14. Wang B, Zhu CR, Liu H, et al. The accuracy of near infrared autofluorescence in identifying parathyroid gland during thyroid and parathyroid surgery: a meta-analysis. Front Endocrinol (Lausanne), 2021, 12: 701253. doi: 10.3389/fendo.2021.701253.
15. Solórzano CC, Thomas G, Berber E, et al. Current state of intraoperative use of near infrared fluorescence for parathyroid identification and preservation. Surgery, 2021, 169(4): 868-878.
16. 杨晓晴, 王正寨, 林溪源, 等. 自体荧光在甲状旁腺研究中的进展. 中国普外基础与临床杂志, 2023, 30(2): 236-241.
17. McWade MA, Paras C, White LM, et al. A novel optical approach to intraoperative detection of parathyroid glands. Surgery, 2013, 154(6): 1371-1377.
18. McWade MA, Sanders ME, Broome JT, et al. Establishing the clinical utility of autofluorescence spectroscopy for parathyroid detection. Surgery, 2016, 159(1): 193-202.
19. Paras C, Keller M, White L, et al. Near-infrared autofluorescence for the detection of parathyroid glands. J Biomed Opt, 2011, 16(6): 067012. doi: 10.1117/1.3583571.
20. McWade MA, Paras C, White LM, et al. Label-free intraoperative parathyroid localization with near-infrared autofluorescence imaging. J Clin Endocrinol Metab, 2014, 99(12): 4574-4580.
21. Thomas G, McWade MA, Paras C, et al. Developing a clinical prototype to guide surgeons for intraoperative label-free identification of parathyroid glands in real time. Thyroid, 2018, 28(11): 1517-1531.
22. Kiernan CM, Thomas G, Patel A, et al. Does the use of probe-based near-infrared autofluorescence parathyroid detection benefit parathyroidectomy?: a randomized single-center clinical trial. Ann Surg, 2023, 278(4): 549-558.
23. 万政, 徐波, 杨晓冬, 等. 基于探针式甲状旁腺近红外自体荧光显像技术在甲状腺手术中的应用. 中华内分泌外科杂志, 2023, 17(4): 404-409.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

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