Emerging Imaging Technologies for Parathyroid Gland Identification and Vascular Assessment in Thyroid Surgery

Author:

Silver Karcioglu Amanda L.123,Triponez Frédéric4,Solórzano Carmen C.5,Iwata Ayaka J.6,Abdelhamid Ahmed Amr H.1,Almquist Martin7,Angelos Peter8,Benmiloud Fares9,Berber Eren10,Bergenfelz Anders11,Cha Jaepyeong1213,Colaianni C. Alessandra14,Davies Louise1516,Duh Quan-Yang1718,Hartl Dana19,Kandil Emad20,Kim Wan Wook21,Kopp Peter A.2223,Liddy Whitney24,Mahadevan-Jansen Anita2526,Lee Kang-Dae27,Mannstadt Michael28,McMullen Caitlin P.29,Shonka David C.30,Shin Jennifer J.3132,Singer Michael C.33,Slough Cristian M.34,Stack Brendan C.35,Tearney Guillermo3637,Thomas Giju3825,Tolley Neil39,Vidal-Fortuny Jordi4041,Randolph Gregory W.142

Affiliation:

1. Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston

2. Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois

3. The University of Chicago, Pritzker School of Medicine, Chicago, Illinois

4. Thoracic and Endocrine Surgery, Department of Surgery, University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland

5. Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee

6. Department of Otolaryngology–Head and Neck Surgery, Kaiser Permanente, Santa Clara, California

7. Department of Surgery, Skane University Hospital, Lund, Sweden, Institution for Clinical Sciences, Lund University, Lund, Sweden

8. MacLean Center for Clinical Medical Ethics, Department of Surgery, The University of Chicago, Chicago, Illinois

9. Endocrine Surgery Unit, Hôpital Européen Marseille, Marseille, France

10. Department of Endocrine Surgery, Cleveland Clinic, Cleveland, Ohio

11. Department of Clinical Sciences-–Lund, Lund University, Lund Sweden

12. Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, Washington, DC

13. Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC

14. Division of Head and Neck Surgery, Department of Otolaryngology–Head and Neck Surgery, Oregon Health & Science University, Portland

15. The VA Outcomes Group, White River Junction, Vermont

16. Section for Otolaryngology–Head & Neck Surgery, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire

17. Section of Endocrine Surgery, Department of Surgery, University of California, San Francisco

18. VA Medical Center, San Francisco, California

19. Department of Surgery, Thyroid Surgery Unit, Gustave Roussy Cancer Campus and University Paris-Saclay, Paris, France

20. Endocrine and Oncological Surgery Tulane University School of Medicine, New Orleans, Louisiana

21. Department of Surgery, Breast and Thyroid Division, Kyungpook National University, South Korea

22. Division of Endocrinology, Diabetology and Metabolism, University of Lausanne, Lausanne, Switzerland

23. Division of Endocrinology, Metabolism and Molecular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois

24. Thyroid and Parathyroid Surgery, Department of Otolaryngology–Head and Neck Surgery, Northwestern Medicine, Chicago, Illinois

25. Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee

26. Department of Surgery, Otolaryngology and Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee

27. Department of Otolaryngology–Head and Neck Surgery, Kosin University Gospel Hospital, Busan, Korea

28. Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston

29. Moffitt Cancer Center, Department of Head & Neck–Endocrine Oncology, Tampa, Florida

30. Division of Head and Neck Surgery, Department of Otolaryngology–Head and Neck Surgery, University of Virginia, Charlottesville

31. Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts

32. Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts

33. Division of Thyroid & Parathyroid Surgery, Department of Otolaryngology–Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan

34. Department of Otolaryngology–Head and Neck Surgery, Hawke’s Bay Fallen Soldiers’ Memorial Hospital, Hawke's Bay District Health Board, Hastings, New Zealand

35. Otolaryngology–Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield

36. Department of Pathology and Wellman Center for Photomedicine, Massachusetts General Hospital, Boston

37. Harvard Medical School, Boston, Massachusetts

38. Vanderbilt Biophotonics Center, Vanderbilt University, Nashville, Tennessee

39. Imperial College NHS Healthcare Trust, London, United Kingdom

40. Department of Thoracic and Endocrine Surgery, University Hospitals of Geneva, Geneva, Switzerland

41. Department of Thoracic and Endocrine Surgery, Geneva, Switzerland

42. Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston

Abstract

ImportanceIdentification and preservation of parathyroid glands (PGs) remain challenging despite advances in surgical techniques. Considerable morbidity and even mortality result from hypoparathyroidism caused by devascularization or inadvertent removal of PGs. Emerging imaging technologies hold promise to improve identification and preservation of PGs during thyroid surgery.ObservationThis narrative review (1) comprehensively reviews PG identification and vascular assessment using near-infrared autofluorescence (NIRAF)—both label free and in combination with indocyanine green—based on a comprehensive literature review and (2) offers a manual for possible implementation these emerging technologies in thyroid surgery.Conclusions and RelevanceEmerging technologies hold promise to improve PG identification and preservation during thyroidectomy. Future research should address variables affecting the degree of fluorescence in NIRAF, standardization of signal quantification, definitions and standardization of parameters of indocyanine green injection that correlate with postoperative PG function, the financial effect of these emerging technologies on near-term and longer-term costs, the adoption learning curve and effect on surgical training, and long-term outcomes of key quality metrics in adequately powered randomized clinical trials evaluating PG preservation.

Publisher

American Medical Association (AMA)

Subject

Otorhinolaryngology,Surgery

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