Int J Thyroidol.  2018 Nov;11(2):92-98. 10.11106/ijt.2018.11.2.92.

Real-Time Localization of Parathyroid Glands with Near Infrared Light during Thyroid and Parathyroid Surgery

• Kim SW
• Jeong YW
• Koh YW
• Lee KD

• KMID: 2448978
• DOI: http://doi.org/10.11106/ijt.2018.11.2.92

Abstract

Intraoperative identification and localization of parathyroid glands are crucial step in preventing postoperative hypocalcemia during thyroid and parathyroid surgery. If there is a method to predict the parathyroid's location rather than detecting and verifying with naked eye, it would make the operator easier to find and identify the parathyroid. Recently, near-infrared light imaging technologies have been introduced in the fields of thyroid and parathyroid surgery to predict the localization of the parathyroid. These are being conducted in two ways: autofluorescence imaging with a unique intrinsic fluorophore in the parathyroid tissues and fluorescence imaging with external fluorescence materials specially absorbed into parathyroid tissues. We are suggest that parathyroid glands can be detected by surgeon with NIR autofluorescence imaging even if they are covered by fibrofatty tissues before they are detected by surgeon's naked eye. These novel techniques are very useful to identify and preserve parathyroid glands during thyroidectomy. In this article, we reviewed the latest papers that describe autofluorescence imaging and exogenous ICG fluorescence imaging of parathyroid glands during thyroid and parathyroid surgery.

Keyword

Parathyroid; Autofluorescence; Fluorescence; Near-infrared; Indocyanine green

MeSH Terms

Fluorescence
Hypocalcemia
Indocyanine Green
Methods
Optical Imaging
Parathyroid Glands*
Thyroid Gland*
Thyroidectomy
Indocyanine Green

Figure

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  Fig. 1 Photos of set up and a graphically illustration. (A) A photo of equipment setting in the operating room. (B) Schematic diagram for detecting autofluorescence of parathyroid tissue with simultaneous illumination of the background tissues.

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  Fig. 2 Images after thyroid lobe lateralization. (A) Inferior and superior parathyroid glands is localized to be in the circle with visible light. (B) Autofluorescence with NIR illuminator image. Autofluorescence emissions coincided with parathyroid glands. Whole surgical field could be visualized by NIR illumination.

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  Fig. 3 Images that is taken immediately after paratracheal exposure without middle thyroid vein ligation. (A) Superior parathyroid underneath the fatty connective tissues was expected (circle), and still covered by background tissues with visible light. (B) Parathyroid glands was not yet exposed, but that was navigated and confirmed with NIR autofluorescence (circle).

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  Fig. 4 Images after thyroid medialization. (A) Visible image by a normal digital camera the superior parathyroid gland was presumed (circle). (B) Near-infrared image was taken with room light-off. Parathyroid autoflorescence signal was stronger than thyroid signal. (C) Dual wavelength image by auto-para viewer (camera used in this experiment) with room light-on. The surgical field was visualized in its original form because part of the visible light entered the camera sensor.

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  Fig. 5 Intraoperative images showing identification of normal parathyroid gland during retroauricular robotic (da Vinci Si system) thyroidectomy. (A) A right inferior parathyroid gland observed under visible light imaging (circle). (B) Ahead of administration of indocyanine green. The parathyroid gland was not clearly distinguishable with NIR mode imaging. (C) After administration of ICG. The fluorescence was observed from the both parathyroid gland (circle) and thyroid gland. The intensity of the parathyroid gland is not as prominent as thyroid gland. Parathyroid fluorescence become gradually marked the parathyroid gland was separated from the thyroid gland.

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  Fig. 6 Images of the parathyroid adenoma. (A) Photo taken with near infrared light after indocyanine green administration, parathyroid adenoma was stained and localized with fluorescence. (B) Parathyroid gland was dissected precisely with guidance of fluorescence. (C) Photo of extracted specimen.

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