Int J Thyroidol.  2022 Nov;15(2):61-67. 10.11106/ijt.2022.15.2.61.

Near Infrared Autofluoroscence (NIRAF) in Thyroid Surgery

• Lee KD

• KMID: 2536490
• DOI: http://doi.org/10.11106/ijt.2022.15.2.61

Abstract

The preservation of the parathyroid gland during thyroid surgery is still challenging; Intraoperative detection of parathyroid glands using near-infrared autofluorescence (NIRAF) has been recently introduced as a solution. NIRAF is noninvasive and it can be applied without contrast dye. Recently, increasing number of studies using NIRAF to detect parathyroid glands under normal or hyperparathyroidism state have been reported, and commercialized products of the imaging devices or probe systems have been produced. NIRAF imaging is also useful to find unrevealed parathyroid gland tissues before exposure, and early localization reduces unintended removal or blood vessel damage of parathyroid glands. It has been reported that this technique significantly decreases the incidence of early postoperative hypocalcemia.

Keyword

Parathyroid glands; Fluorescence; Near-infrared autofluorescence

Figure

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  Fig. 1 Emission of 822 nm autofluorescence from the fluorophore of the parathyroid gland (arrow) by excitation with 785 nm NIR light.

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  Fig. 2 Fluorescence spectra measured from parathyroid, thyroid fat, muscle and trachea. Near infrared (NIR) light can discriminate the parathyroid gland from surrounding tissues.

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  Fig. 3 Author’s laboratory-built NIRAF imaging system to identify parathyroid glands. When NIR light (785 nm) is illuminated to the surgical field (short arrow), the 822 nm of NIRAF is emitted from the fluorophore of parathyroid gland (long arrow) and then the camera detects the NIRAF. No need to use any exogenous contrast dye during the procedure (NIRAF, near-infrared autofluorescence).

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  Fig. 4 Left thyroid lobe is mobilized and inferior parathyroid gland is exposed (A). The NIRAF image shows the glowing of the parathyroid gland (B). Surrounding tissues have no significant autofluorescence intensity.

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  Fig. 5 Parathyroid gland mapping. In the white light image (A), no parathyroid glands can be seen with naked eye. Interestingly, with author’s lab-built NIRAF imager, the unexposed right inferior parathyroid gland can be clearly localized by mapping (B).

Reference

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