Impact of autofluorescence-based identification of parathyroids during total thyroidectomy on postoperative hypocalcemia: a before and after controlled study

• Published in: Surgery Vol. 163; no. 1; pp. 23 - 30
• Main Authors: Benmiloud, Fares, Rebaudet, Stanislas, Varoquaux, Arthur, Penaranda, Guillaume, Bannier, Marie, Denizot, Anne
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-01-2018; Elsevier
• Subjects: Engineering Sciences
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2017.06.022

The clinical impact of intraoperative autofluorescence-based identification of parathyroids using a near-infrared camera remains unknown.
In a before and after controlled study, we compared all patients who underwent total thyroidectomy by the same surgeon during Period 1 (January 2015 to January 2016) without near-infrared (near-infrared− group) and those operated on during Period 2 (February 2016 to September 2016) using a near-infrared camera (near-infrared+ group). In parallel, we also compared all patients who underwent surgery without near-infrared during those same periods by another surgeon in the same unit (control groups). Main outcomes included postoperative hypocalcemia, parathyroid identification, autotransplantation, and inadvertent resection.
The near-infrared+ group displayed significantly lower postoperative hypocalcemia rates (5.2%) than the near-infrared− group (20.9%; P < .001). Compared with the near-infrared− patients, the near-infrared+ group exhibited an increased mean number of identified parathyroids and reduced parathyroid autotransplantation rates, although no difference was observed in inadvertent resection rates. Parathyroids were identified via near-infrared before they were visualized by the surgeon in 68% patients. In the control groups, parathyroid identification improved significantly from Period 1 to Period 2, although autotransplantation, inadvertent resection and postoperative hypocalcemia rates did not differ.
Near-infrared use during total thyroidectomy significantly reduced postoperative hypocalcemia, improved parathyroid identification and reduced their autotransplantation rate.