Emerging Imaging Technologies for Parathyroid Gland Identification and Vascular Assessment in Thyroid Surgery
Amanda L. Silver Karcioglu, Frédéric Triponez, Carmen C. Solórzano, Ayaka J. Iwata, Amr H. Abdelhamid Ahmed, Martin Almquist, Peter Angelos, Fares Benmiloud, Eren Berber, Anders Bergenfelz, Jaepyeong Cha, C. Alessandra Colaianni, Louise Davies, Quan‐Yang Duh, Dana M. Hartl, Emad Kandil, Wan Wook Kim, Peter Kopp, Whitney Liddy, Anita Mahadevan‐Jansen, Kang‐Dae Lee, Michael Mannstadt, Caitlin McMullen, David C. Shonka, Jennifer J. Shin, Michael C. Singer, Cristian M. Slough, Brendan C. Stack, Guillermo J. Tearney, Giju Thomas, Neil Tolley, Jordi Vidal-Fortuny, Gregory W. Randolph
Abstract
Importance: Identification and preservation of parathyroid glands (PGs) remain challenging despite advances in surgical techniques. Considerable morbidity and even mortality result from hypoparathyroidism caused by devascularization or inadvertent removal of PGs. Emerging imaging technologies hold promise to improve identification and preservation of PGs during thyroid surgery. Observation: This narrative review (1) comprehensively reviews PG identification and vascular assessment using near-infrared autofluorescence (NIRAF)-both label free and in combination with indocyanine green-based on a comprehensive literature review and (2) offers a manual for possible implementation these emerging technologies in thyroid surgery. Conclusions and Relevance: Emerging technologies hold promise to improve PG identification and preservation during thyroidectomy. Future research should address variables affecting the degree of fluorescence in NIRAF, standardization of signal quantification, definitions and standardization of parameters of indocyanine green injection that correlate with postoperative PG function, the financial effect of these emerging technologies on near-term and longer-term costs, the adoption learning curve and effect on surgical training, and long-term outcomes of key quality metrics in adequately powered randomized clinical trials evaluating PG preservation.