Emerging Imaging Technologies for Parathyroid Gland Identification and Vascular Assessment in Thyroid Surgery: A Review From the American Head and Neck Society Endocrine Surgery Section

Amanda L. Silver Karcioglu, Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston.
Frédéric Triponez, Thoracic and Endocrine Surgery, Department of Surgery, University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland.
Carmen C. Solórzano, Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
Ayaka J. Iwata, Department of Otolaryngology-Head and Neck Surgery, Kaiser Permanente, Santa Clara, California.
Amr H. Abdelhamid Ahmed, Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston.
Martin Almquist, Department of Surgery, Skane University Hospital, Lund, Sweden, Institution for Clinical Sciences, Lund University, Lund, Sweden.
Peter Angelos, MacLean Center for Clinical Medical Ethics, Department of Surgery, The University of Chicago, Chicago, Illinois.
Fares Benmiloud, Endocrine Surgery Unit, Hôpital Européen Marseille, Marseille, France.
Eren Berber, Department of Endocrine Surgery, Cleveland Clinic, Cleveland, Ohio.
Anders Bergenfelz, Department of Clinical Sciences--Lund, Lund University, Lund Sweden.
Jaepyeong Cha, Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC.
C Alessandra Colaianni, Division of Head and Neck Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland.
Louise Davies, The VA Outcomes Group, White River Junction, Vermont.
Quan-Yang Duh, Section of Endocrine Surgery, Department of Surgery, University of California, San Francisco.
Dana Hartl, Department of Surgery, Thyroid Surgery Unit, Gustave Roussy Cancer Campus and University Paris-Saclay, Paris, France.
Emad Kandil, Endocrine and Oncological Surgery Tulane University School of Medicine, New Orleans, Louisiana.
Wan Wook Kim, Department of Surgery, Breast and Thyroid Division, Kyungpook National University, South Korea.
Peter A. Kopp, Division of Endocrinology, Diabetology and Metabolism, University of Lausanne, Lausanne, Switzerland.
Whitney Liddy, Thyroid and Parathyroid Surgery, Department of Otolaryngology-Head and Neck Surgery, Northwestern Medicine, Chicago, Illinois.
Anita Mahadevan-Jansen, Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee.
Kang-Dae Lee, Department of Otolaryngology-Head and Neck Surgery, Kosin University Gospel Hospital, Busan, Korea.
Michael Mannstadt, Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston.
Caitlin P. McMullen, Moffitt Cancer Center, Department of Head & Neck-Endocrine Oncology, Tampa, Florida.
David C. Shonka, Division of Head and Neck Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville.
Jennifer J. Shin, Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts.
Michael C. Singer, Division of Thyroid & Parathyroid Surgery, Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan.
Cristian M. Slough, Department of Otolaryngology-Head and Neck Surgery, Hawke's Bay Fallen Soldiers' Memorial Hospital, Hawke's Bay District Health Board, Hastings, New Zealand.
Brendan C. Stack, Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield.
Guillermo Tearney, Department of Pathology and Wellman Center for Photomedicine, Massachusetts General Hospital, Boston.
Giju Thomas, Vanderbilt Biophotonics Center, Vanderbilt University, Nashville, Tennessee.
Neil Tolley, Imperial College NHS Healthcare Trust, London, United Kingdom.
Jordi Vidal-Fortuny, Department of Thoracic and Endocrine Surgery, University Hospitals of Geneva, Geneva, Switzerland.

Document Type

Journal Article

Publication Date

1-12-2023

Journal

JAMA otolaryngology-- head & neck surgery

DOI

10.1001/jamaoto.2022.4421

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.

Department

Pediatrics

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