However, there are significant differences in study design, inclusions, definitions and management protocol between reported studies ( 6- 8). To overcome this, near-infrared (NIR) fluorescence imaging with indocyanine green (ICG) imaging has been recently introduced and has been suggested as a useful tool for the identification and preservation of the PGs ( 4, 5). Therefore, there is no proven or reliable non-invasive intraoperative method to identify PG and assess PG vascularization ( 3). The current identification method is usually based on visual inspection and palpation by the surgeon with careful preservation of the PG blood supply, depending greatly on the surgeon’s experience ( 1).Īlthough inspection and palpation are still the main tools, several other techniques have been proposed for PG visualization and perfusion, but most are of limited value or have become obsolete.
The frozen section analysis requires sacrificing a PG slice while the “float or sink” method is based on tissue density and thereafter a PG autotransplantation is needed ( 2). Intraoperatively, the identification of PGs can be performed by two invasive alternatives: i) the frozen section method or ii) the “float or sink” technique. Intraoperative identification of the parathyroid glands (PG) is a major concern either during parathyroidectomy (PTX) or when performing total thyroidectomy (TT) ( 1). Despite all this, ICG fluorescence imaging technique for PG detection still lacks standardization and further studies are needed to establish its clinical utility. Conclusion: ICG fluorescence imaging is a simple, fast and reproducible method capable of intraoperatively visualizing and assessing the function of parathyroid glands, and can, therefore, assist surgeons in their decision-making. Eleven publications reported the use of ICG angiography for the identification of the parathyroid glands during thyroidectomy and seven during parathyroidectomy for primary and secondary hyperparathyroidism.
Results: Eighteen publications reporting on 612 patients, namely 71 parathyroidectomy and 541 thyroidectomy patients met the inclusion criteria. Materials and Methods: The PubMed database was systematically searched for publications regarding intraoperative ICG imaging in patients that undergo thyroidectomy or parathyroidectomy. The aim of this review is to investigate the use of ICG angiography during thyroidectomy and/or parathyroidectomy for identification as well as for the perfusion integrity of the parathyroid glands. However, an overall consensus on the optimal technique, the dosage, the timing of the ICG administration and finally its interpretation and clinical usefulness is still lacking evidence. Background/Aim: Recently, indocyanine green (ICG) fluorescence imaging has been used for the identification of the parathyroid glands (PG) during thyroid and parathyroid surgery.
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