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Aportaciones de la fluorescencia a la cirugía endocrina
摘要： The use of fluorescence in surgery has expanded and become widespread in recent years, which has led to a real technological phenomenon with the emergence of devices adapted for use in laparoscopic and robotic approaches. Fluorescence-guided surgery in the field of endocrine surgery is also on the rise. More and more articles describe its use in surgery of the thyroid, parathyroid and adrenal glands, although the series are still modest in size and protocols have not been standardized. There are currently several developing areas for the application of fluorescence in endocrine surgery, including the use of fluorescence with indocyanine green in adrenal gland surgery, the identification and prediction of parathyroid perfusion with indocyanine green, and autofluorescence of the parathyroid glands. The objective of this article is to review the current applications of fluorescence in endocrine surgery.
关键词： Thyroid surgery,Parathyroid surgery,Indocyanine green,Endocrine surgery,Fluorescence-guided surgery,Adrenal surgery,Autofluorescence
更新于2025-09-23 15:23:52
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Research on indocyanine green angiography for predicting postoperative hypoparathyroidism
摘要： Background: It may be critical to locate the parathyroid for surgeons during thyroidectomy or parathyroidectomy due to the significant function of the parathyroid in calcium balance. According to recent reports, the intrinsic fluorescence of the parathyroid has been found. There is some evidence supporting that new equipment can detect fluorescence via imaging technology. In this study, a newly-invented intraoperative fluorescence imaging system and indocyanine green dye were applied to detect the parathyroid glands and evaluate the vascularization of the parathyroid. The report is as follows. Methods: From May 1st to August 8st, 2018, 26 patients underwent total thyroidectomy in Zhuhai People’s Hospital and were recruited into our research. All identified parathyroid glands were scored visually from grade 0 to grade 2 according to the vascularity of the parathyroid before ICG angiography was performed. After ICG angiography, parathyroid glands were scored from score 0 to score 2 according to the FI. Results: Visual scores were significantly higher than ICG angiography scores. In the 22 patients with at least one parathyroid gland with an ICG score of 2, postoperative PTH levels were in the normal range. In the 4 patients with no parathyroid gland with an ICG score of 2, 2 of them developed transient hypoparathyroidism, with recovery on POD 7 for the first patient and after 3 months for the second one. Conclusion: This study has identified that the fluorescence imaging system applied with indocyanine green is a safe, easy and effective method to protect the parathyroid and predict postoperative hypoparathyroidism. Registration number: ChiCTR1800016864.
关键词： Fluorescence imaging system,Indocyanine green,Postoperative hypoparathyroidism.,Parathyroid
更新于2025-09-23 15:23:52
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Prediction of hypocalcemia after total thyroidectomy using indocyanine green angiography of parathyroid glands: a simple quantitative scoring system.
摘要： Background: Hypocalcemia is one of the most common complications after total thyroidectomy. Recently, indocyanine green (ICG) angiography of the parathyroid glands (PGs) has been suggested as a reliable tool for predicting postoperative hypocalcemia. The aim of our study was to evaluate the performance of a simple quantitative score based on ICG angiography of the PGs (4-ICG score) for predicting postoperative hypocalcemia. Methods: Thirty nine consecutive patients who underwent total thyroidectomy for multinodular goiter were included. For each patient, the 4-ICG score was calculated, adding the individual viability value of the four PGs. Discrimination and correlation analyses were performed. Results: In 32/39 patients, the four PGs were identified. Patients with postoperative hypocalcemia (n=6, 19%) had a lower 4-ICG score (2.5 [1.8–3.3] vs. 4.0 [3.0–6.0]; p = .003). The 4-ICG score showed good discrimination in terms of predicting postoperative hypocalcemia (AUC=0.875 (0.710–0.965); p=.001) and a good correlation with postoperative parathyroid function. Conclusions: The 4-ICG score predicts postoperative hypocalcemia and correlates well with postoperative parathyroid function in patients undergoing total thyroidectomy for multinodular goiter.
关键词： Parathyroid hormone,Indocyanine green,Multinodular goiter.,Parathyroid,Thyroidectomy,Hypocalcemia
更新于2025-09-23 15:22:29
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Indocyanine green-enhanced fluorescence for assessing parathyroid perfusion during thyroidectomy
摘要： Identification of the parathyroid glands during thyroid surgery may prevent their inadvertent surgical removal and thus provide a better postoperative quality of life. Nevertheless, the most common “technique” for intraoperative evaluation of perfusion of parathyroid gland tissues during thyroid surgery is visual inspection of the physical condition of tissues, e.g., their color and bleeding edges. Another technique is measurement of intact parathyroid hormone. Recently, indocyanine green-enhanced fluorescence has been used in various surgical techniques, particularly laparoscopic surgery, to improve visualization and to provide detailed anatomical information. Fluorescent optical guidance helps surgeons to avoid inadvertent tissue injury while enhancing procedural efficiency. This technique has potential use for evaluating perfusion of the parathyroid gland in real-time intraoperative angiography.
关键词： Indocyanine green (ICG),thyroidectomy,parathyroid,hypocalcemia,fluorescence
更新于2025-09-23 15:22:29
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US-guided laser treatment of parathyroid adenomas
摘要： Objective: To determine the clinical efficacy of laser ablation for the treatment of primary hyperparathyroidism (pHPT). Materials and methods: Twelve patients with pHPT were treated with laser ablation. Energy was administered by means of 1.5 m optical fibers percutaneously placed into the target via 21 G needles. A laser ablation unit (EchoLaser X4, Esaote) applied 3 W power for 400–600 s/fiber/insertion to a total 3600–9000 Joules of energy. Patient serum parathyroid hormone (PTH) and calcium levels were checked at baseline and thereafter every 6 months. Patients were followed-up for 2 years with serologic and contrast-enhanced ultrasound. Therapeutic success was defined as normal PTH and calcium levels together with disappearance of nodule-related symptoms. Results: All procedures were performed in single session. Immediately following ablation, contrast enhanced ultrasound confirmed that all but one target had become avascular (technical success rate 11/12; 92%), remaining avascular at all follow-up ultrasound examinations, thereafter. The mean volume of parathyroid nodules decreased from 0.54 cc to 0.36 cc (72.0%). Serum PTH and calcium levels were significantly lower at 1, 12 and 24 m compared to baseline (p < 0.01). By 6 m, PTH and calcium returned to normal and were stable until 24 m in all successfully treated patients. All cases of hyperparathyroid-related symptoms resolved by 6 m (ostealgia [n ? 5], repeated renal colic [n ? 5], vomiting [n ? 3]). Only one patient (8%) reported transient dysphonia as a minor complication. Conclusion: Laser ablation of enlarged, symptomatic parathyroid glands is safe and well-tolerated and can produce long-term, sustained reduction of serum PTH and calcium levels.
关键词： primary hyperparathyroidism,parathyroid adenoma,parathyroid ablation,Laser ablation
更新于2025-09-23 15:19:57
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The use of ICG enhanced fluorescence for the evaluation of parathyroid gland preservation
摘要： Indocyanine green (ICG) enhanced fluorescence imaging is recent innovation as the “real-time intraoperative imaging” technique. Many clinical studies have been reported in the literature which use different devices and techniques that employ various doses and usages of ICG as a non-specific contrast agent. Several groups have performed studies in endocrine surgery, especially with regards to parathyroid-related outcomes after thyroid and parathyroid surgery. However, there is no consensus on the technical details that should be applied. With this study, we aimed to review the current literature on potential use of intraoperative ICG angiography for evaluating parathyroid gland (PTG) preservation.
关键词： parathyroid,Indocyanine green,preservation,ICG
更新于2025-09-19 17:15:36
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Comparison of indocyanine green fluorescence and parathyroid autofluorescence imaging in the identification of parathyroid glands during thyroidectomy
摘要： Background: Indocyanine green fluorescence (ICGF) and parathyroid autofluorescence (AF) are two new techniques that aid in the identification of parathyroid glands (PG) intraoperatively during thyroidectomy. There is no study comparing the efficacy of these techniques. Methods: This was an IRB-approved clinical study comparing the utility of ICGF and AF for identification of PGs during thyroidectomy. Data were collected prospectively. Both techniques were compared to naked eye (NE) for PG detection. Standard statistical methods were used for data analysis. Results: Twenty-two patients in each group underwent a total of 39 total thyroidectomies and 5 thyroid lobectomies. AF and ICGF had similar detection rates for PGs [98% (61 of 62) and 95% (60 of 63) of PGs, respectively; P=0.31]. The location of PGs was suggested before detection with NE more frequently by AF than ICGF [52% (32 of 62) vs. 6% (4 of 63) of PGs; P<0.001]. In 82% (18 of 22) of patients at least one PG was detected by AF before NE, as opposed to 14% (3 of 22) by ICGF (P<0.001). The median (range) number of PGs detected before NE per patient was greater with AF than ICGF [2 (0–3) vs. 0 (0–2)]. Upper PGs were more likely to be detected by AF before recognition with NE than the lower ones (P=0.03). There was no predictive factor for ICGF detection. Postoperative hypocalcemia rates were similar [9% (2 of 22) and 5% (1 of 22) for AF and ICGF, respectively; P>0.99]. Conclusions: To the best of our knowledge, this is the first comparative study between parathyroid AF and ICGF in detection of PGs during thyroidectomy. Our data suggest both techniques have similarly high detection rates and that the main difference lies in the timing of detection. AF more frequently detects PGs before recognition with NE compared to ICGF.
关键词： Parathyroid autofluorescence (AF),indocyanine green fluorescence (ICGF),thyroid surgery
更新于2025-09-19 17:15:36
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Application of a Fluorescence Imaging System with Indocyanine Green to Protect the Parathyroid Gland Intraoperatively and to Predict Postoperative Parathyroidism
摘要： Identifying the parathyroid gland during surgery may be difficult for surgeons. It is critical for them to be able to locate it during thyroidectomy or parathyroidectomy because of the significant function of the parathyroid in the calcium balance. According to recent reports, intrinsic fluorescence of the parathyroid has been found. There is some evidence to suggest that new equipment can detect the fluorescence via imaging technology. In this study, a newly invented intraoperative fluorescence imaging system and indocyanine green (ICG) dye were applied to detect the parathyroid glands and evaluate the vascularization of the parathyroid.
关键词： Postoperative parathyroidism,Indocyanine green,Parathyroid,Fluorescence imaging system
更新于2025-09-10 09:29:36
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Parathyroid gland management using optical technologies during thyroidectomy or parathyroidectomy: A systematic review
摘要： New optical technologies enhancing localization or assessing viability of parathyroid glands (PG) during endocrine surgery have been reported in clinical studies. These technologies could become complementary to the surgeon’s eyes and may improve surgical outcomes in thyroidectomy and parathyroidectomy. Here, we conducted a systematic review focusing on PG identification and functional assessment using optical methods to enhance surgery. A systematic literature review was performed using MEDLINE and Embase database. Two authors selected studies and extracted data; qualitative analysis was performed to summarize the characteristics of reported optical tools for thyroidectomy or parathyroidectomy. Identification and vascularisation of PG during surgery were evaluated. Clinical and biochemical outcomes were appraised when reported. Studies relating to parathyroidectomy or thyroidectomy combined with autofluorescence, fluorescent methylene blue, 5-aminolevulinic acid, indocyanine green (ICG), optical coherence tomography, laser speckle contrast imaging, dynamic optical contrast imaging and Raman spectroscopy were identified with MEDLINE and Embase. We included a total of 47 relevant articles with a total of 1615 patients enrolled. Each optical technique is described and appreciated related to its surgical purpose. Autofluorescence and ICG imaging of PG are the most widely reported optical technologies for identification and assessment of vascularisation of PG. Results are mainly based on observational studies and argue for the feasibility of both techniques in endocrine surgery but prospective randomized studies have not been performed. In vivo applications are still limited for the other methods and further investigations correlating these techniques with post-operative parathormone measurements are still needed before considering these technologies in clinical practice.
关键词： Surgery,Fluorescence,Dynamic optical contrast imaging,Laser speckle contrast imaging,Optical coherence tomography,Raman spectroscopy,Parathyroid gland
更新于2025-09-10 09:29:36
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Feasibility of indocyanine green fluorescence imaging for intraoperative identification of parathyroid glands during thyroid surgery
摘要： Background: This study assessed 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. Methods: Patients undergoing elective thyroidectomy were enrolled in this prospective study. An intravenous bolus of 7.5 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. Results: A total of 30 operations in 26 patients were included. In 17 surgeries (56.7%), fluorescence imaging was of added value, especially to confirm the presence of a suspected PG. No intraoperative or postoperative complications occurred because of the use of ICG. Conclusion: 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.
关键词： near-infrared fluorescence imaging,thyroidectomy,NIRF,indocyanine green,parathyroid gland
更新于2025-09-04 15:30:14