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Surgery. 2018 Jan;163(1):23-30. doi: 10.1016/j.surg.2017.06.022. Epub 2017 Nov 6.

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

Author information

1
Endocrine Surgery Unit, Hôpital Européen de Marseille, Marseilles, France. Electronic address: f.benmiloud@hopital-europeen.fr.
2
Internal Medicine Unit, Hôpital Européen de Marseille, Marseilles, France.
3
Radiology Unit, Hôpital La Timone, Hospital-APHM, Marseilles, France.
4
Biostatistics Unit, Laboratoire Alphabio, Marseilles, France.
5
Oncologic Surgery Unit, Institut Paoli-Calmettes, Marseilles, France.
6
Endocrine Surgery Unit, Hôpital Européen de Marseille, Marseilles, France.

Abstract

BACKGROUND:

The clinical impact of intraoperative autofluorescence-based identification of parathyroids using a near-infrared camera remains unknown.

METHODS:

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.

RESULTS:

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.

CONCLUSION:

Near-infrared use during total thyroidectomy significantly reduced postoperative hypocalcemia, improved parathyroid identification and reduced their autotransplantation rate.

Comment in

PMID:
29122325
DOI:
10.1016/j.surg.2017.06.022
[Indexed for MEDLINE]

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