Abstract
Background: Postoperative hypocalcemia is the most frequent complication of the total thyroidectomy. New techniques have recently emerged for the identification of the parathyroid glands, for example fluorescence with indocinaine green, which has been very well accepted by different groups of expert surgeons internationally. In this study we use it to assess the viability of the parathyroid glands after total thyroidectomy with the angiography image that it provides us.
Methods:
This is a cohort study including patients undergoing total thyroidectomy in 2020 using ICG fluorescence and they were evaluated for transient and permanent (>6 months) hypocalcemia postoperatively. In addition, results were compared with historical controls including patients treated by a low-volume thyroid surgeon (group A), and by a high-volume thyroid surgeon (group B). Several variables were included (number of auto-transplanted parathyroids, postoperative serum calcium leves, and symptoms of hypocalcemia) and analyzed between groups. The main aim of the study was to determine whether the use of ICG fluorescence associateswith a lower rate of postoperative hypocalcemia.
Results: A total of 18 patients were operated using ICG fluorescence. Of them 14 (75%) cases were females and median age were 54 ±13.5 years. 29 patients were included in group A (operated by a low-volume thyroid surgeon) and 50 patients in group B (by a high-volume thyroid surgeon). Autotransplantation was no necessary in ICG group compared with 3 and 1 in the group A and B respectively. Thyroid cancer were confirmed in 58 (59%) of cases by histopathology. Postoperative calcium levels were higher in ICG fluorescence group compared with groups A and B since day-1 to 6 months of follow-up (p=NS). Statistical analysis showed a significant difference in transient hypocalcemia and permanent hypoparathyroidism rates (p=0.011 and p=0.002 respectively) when contrasted between groups. The sub-analysis showed that ICG-fluorescence did not reach adequate statistical significance compared to group of high-volume surgeon (B), both for transient and permanent hypocalcemia (p= 0.039 and p= 0.28 respectively).
Conclusions: ICG fluorescence technique was associated with lower incidence of postoperative hypocalcemia specially when it is compared to low-volume thyroid surgeon.