Combined near-infrared autofluorescence and preresection indocyanine green angiography for parathyroid gland preservation during thyroid surgery: A clinical controlled trial

Abstract

Background: This was a single-institution controlled trial examining whether the intraoperative combination of near-infrared-induced autofluorescence of the parathyroid glands and preresection indocyanine green near-infrared angiograms of the parathyroid feeding vessels can reduce the incidence of postoperative hypoparathyroidism 1 year after surgery in patients undergoing total or completion thyroidectomy. Methods: Included patients underwent total or completion thyroidectomy. The intervention group was prospective and underwent surgery with bimodal near-infrared-induced autofluorescence of the parathyroid glands and preresection indocyanine green near-infrared angiograms. The control group was retrospective and underwent standard surgery. Patients were matched with a 1:3 ratio for intervention/control. Minimal matching criteria were procedure (completion/total thyroidectomy), surgical indication (compressive symptoms/hyperthyroidism/suspicion or diagnosis of cancer), substernal goiter, and lymph node resection/neck dissection. The primary outcome was hypoparathyroidism 1 year after surgery, defined as treatment with an active vitamin D analogue. Results: A total of 154 intervention patients were included and matched with 462 control patients. The incidence of hypoparathyroidism 1 year after surgery was 6.5% in the intervention group and 12.3% in the control group. The risk of hypoparathyroidism 1 year after surgery was significantly lower in the intervention group compared with control patients (odds ratio, 0.50; 95% confidence interval, 0.248–0.996). The difference was even more pronounced after adjustment for potential confounders (sex, age, body mass index, perioperative blood loss, weight of both thyroid lobes, former central neck surgery, operating surgeon) (odds ratio, 0.16; 95% confidence interval, 00.048–0.560). Conclusion: The bimodal application of near-infrared-induced autofluorescence of the parathyroid glands and pre-resection indocyanine green near-infrared angiograms during total and completion thyroidectomy significantly reduces the risk of hypoparathyroidism 1 year after surgery.