研究目的
To assess the feasibility of near-infrared fluorescence imaging with indocyanine green (ICG) to identify the parathyroid glands (PGs) intraoperatively and to assess their perfusion after thyroid resection.
研究成果
Near-infrared fluorescence imaging with the use of ICG for intraoperative identification of the PGs and the assessment of its vascularization is feasible and safe and can provide more certainty about the location of the PGs.
研究不足
As the study was designed to be a feasibility study, a small number of patients were included, of which a minority of patients underwent a total or completion thyroidectomy. Therefore, only 12 patients were actually at risk of permanent hypoparathyroidism. The calcium-ion level was measured postoperatively in the patients after a total thyroidectomy. However, a limitation of this study is that we could not histologically check the tissue we saw as parathyroid tissue in NIRF because of ethical reasons.
1：Experimental Design and Method Selection:
Patients undergoing elective thyroidectomy were enrolled in this prospective study. An intravenous bolus of
2：5 mg ICG was administered twice:
the first bolus to identify the PGs before resection of the thyroid and the second to assess vascularization of the PGs after resection.
3：Sample Selection and Data Sources:
Consecutive men and women patients, aged 18 years and older, scheduled for elective total, hemithyroidectomy or completion thyroidectomy, with a normal liver and renal function and with written informed consent were eligible for inclusion.
4：List of Experimental Equipment and Materials:
A commercially available laparoscopic fluorescence imaging system (Karl Storz GmbH & CO., Tuttlingen, Germany), including a plasma light guide, a 30° 10 mm laparoscope applicable for near infrared (NIR) light was used. ICG (VERDYE, Diagnostic Green GmbH, Aschheim-Dornacht, Germany) was administered intravenously.
5：Experimental Procedures and Operational Workflow:
Observations were done using white light, from the regular operation room-lights and without camera, and in NIRF mode, using the dedicated system. Video recordings were made using the laparoscopic system.
6：Data Analysis Methods:
The fluorescence intensity was analyzed using OsiriX Lite V8.5.2 Imaging software (Pixmeo, Geneva, Switzerland) to determine the target-to-background ratio (TBR).
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