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Barbieri D, Indelicato P, De Leo S, Moneta C, Coccia S, Gazzano G, Giordano L, Luce FL, Canta D, Fugazzola L, Bussi M, Dionigi G, Trevisan M. Will the autofluorescence take over inadvertent parathyroidectomy? Results from a multicentre cohort study. Updates Surg 2025; 77:369-380. [PMID: 39825021 DOI: 10.1007/s13304-025-02083-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Accepted: 01/07/2025] [Indexed: 01/20/2025]
Abstract
BACKGROUND Recently, several devices exploiting the near-infrared autofluorescence (NIR-AF) of parathyroid glands (PGs) have been developed. Nevertheless, their impact on both preserving PGs from inadvertent surgical dissection and on post-surgical hypoparathyroidism (hypoPTH) is controversial. METHODS A retrospective study of 845 patients undergoing thyroid surgery in 2 academic tertiary centres was conducted. In 291 patients, a NIR-AF device was used during surgery to identify PGs. The characteristics of the cohort were examined. The number of PGs identified during surgery, missed PGs, auto-transplants, inadvertent parathyroidectomies, as well as the occurrence of transient and permanent hypoPTH, were analysed. RESULTS The use of NIR-AF device resulted in a higher identification of PGs (92% versus 88%, p = 0.0008), and a significant reduction in the number of PGs inadvertently removed and detected on histopathological examination (4.7% versus 6.5%, p = 0.045). An increase in PG auto-transplantations was observed in the NIR-AF + group (10.4% versus 3.5%, p < 0.0001). The use of NIRAF did not significantly impact the occurrence of either transient or permanent hypoPTH. CONCLUSION Intraoperative NIR-AF detection is a promising technology to reduce incidental parathyroidectomies in thyroid surgery. The impact of this technology on the occurrence of post-surgical hypoPTH needs to be furtherly investigated.
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Affiliation(s)
- Diego Barbieri
- Division of Head and Neck, San Raffaele Scientific Institute IRCCS (Istituto Di Ricovero E Cura a Carattere Scientifico), Otorhinolaryngology Unit, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Pietro Indelicato
- Division of Head and Neck, San Raffaele Scientific Institute IRCCS (Istituto Di Ricovero E Cura a Carattere Scientifico), Otorhinolaryngology Unit, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Simone De Leo
- Endocrine Oncology Unit, Istituto Auxologico Italiano IRCCS (Istituto Di Ricovero E Cura a Carattere Scientifico), Milan, Italy
| | - Claudia Moneta
- Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | | | - Giacomo Gazzano
- Pathology Unit, Istituto Auxologico Italiano IRCCS (Istituto Di Ricovero E Cura a Carattere Scientifico), Milan, Italy
| | - Leone Giordano
- Division of Head and Neck, San Raffaele Scientific Institute IRCCS (Istituto Di Ricovero E Cura a Carattere Scientifico), Otorhinolaryngology Unit, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesca Lira Luce
- Division of Head and Neck, San Raffaele Scientific Institute IRCCS (Istituto Di Ricovero E Cura a Carattere Scientifico), Otorhinolaryngology Unit, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Davide Canta
- Division of Head and Neck, San Raffaele Scientific Institute IRCCS (Istituto Di Ricovero E Cura a Carattere Scientifico), Otorhinolaryngology Unit, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Laura Fugazzola
- Endocrine Oncology Unit, Istituto Auxologico Italiano IRCCS (Istituto Di Ricovero E Cura a Carattere Scientifico), Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Via Mercalli 28, 20155, Milan, Italy
| | - Mario Bussi
- Division of Head and Neck, San Raffaele Scientific Institute IRCCS (Istituto Di Ricovero E Cura a Carattere Scientifico), Otorhinolaryngology Unit, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Gianlorenzo Dionigi
- Department of Pathophysiology and Transplantation, University of Milan, Via Mercalli 28, 20155, Milan, Italy.
- Division of Surgery, Istituto Auxologico Italiano IRCCS (Istituto Di Ricovero E Cura a Carattere Scientifico), Via Mercalli 28, 20155, Milan, Italy.
| | - Matteo Trevisan
- Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
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Maseki T, Furuki K, Sugiyama R, Nakazawa M, Komoto M, Maeno M. Enamel microcrack inspection using near-infrared light transillumination with fluorescence staining. Dent Mater J 2025; 44:73-77. [PMID: 39631954 DOI: 10.4012/dmj.2023-336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2024]
Abstract
Enamel microcracks are often apparent in the teeth of elderly individuals. However, accurate clinical diagnosis of enamel microcracks is very difficult. The purpose of this study was to examine the utility of inspections for enamel microcracks using a near-infrared light transillumination device with fluorescence staining. Human upper incisors with typical enamel microcracks were selected. Grayscale pictures of each tooth specimen were then taken by digital camera under visible light as control. Every tooth specimen was stained using indocyanine green solutions, then examined, and photographed under visible light. All digital images were compared with the background enamel surface and measured using image analysis software. Inspection using near-infrared light transillumination with indocyanine green solution was effective for detecting the presence of enamel microcracks. This method offers a non-invasive method of chair-side diagnosis and appears effective for detecting the presence of enamel microcracks.
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Affiliation(s)
- Toshio Maseki
- Department of Adhesive Dentistry, School of Life Dentistry at Tokyo, The Nippon Dental University
| | - Kensuke Furuki
- Department of Adhesive Dentistry, School of Life Dentistry at Tokyo, The Nippon Dental University
| | - Reo Sugiyama
- Department of Adhesive Dentistry, School of Life Dentistry at Tokyo, The Nippon Dental University
| | - Miwa Nakazawa
- Department of Adhesive Dentistry, School of Life Dentistry at Tokyo, The Nippon Dental University
| | - Mei Komoto
- Department of Adhesive Dentistry, School of Life Dentistry at Tokyo, The Nippon Dental University
| | - Masahiko Maeno
- Department of Adhesive Dentistry, School of Life Dentistry at Tokyo, The Nippon Dental University
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3
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Indelicato P, Barbieri D, Salerno E, Tettamanti A, Guizzardi MT, Galli A, Frattini F, Giordano L, Bussi M, Dionigi G. Near-Infrared Autofluorescence or Intraoperative Parathyroid Hormone Determination as a Surgical Support Tool in Primary Hyperparathyroidism: Too Close to Call? Cancers (Basel) 2024; 16:4018. [PMID: 39682204 DOI: 10.3390/cancers16234018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2024] [Revised: 11/12/2024] [Accepted: 11/27/2024] [Indexed: 12/18/2024] Open
Abstract
Background: This study investigates the use of near-infrared fluorescence imaging (NIFI) as an alternative to intraoperative parathyroid hormone (ioPTH) measurement in patients with primary hyperparathyroidism (PHP) due to parathyroid adenoma (PA) with two preoperative imaging examinations in agreement on the position of the altered parathyroid gland. Methods: Fifty patients who underwent minimally invasive parathyroidectomy (MIP) from March 2021 to April 2024 were enrolled. MIPs utilised both NIFI and ioPTH, comparing the time to adenoma excision with NIFI against the total surgical time, including ioPTH measurement wait time. Results: Results showed successful MIPs in all patients, with a mean excision time of 44.7 min (SD ± 25.2) and a total procedure time of 85.5 min (SD ± 37.1). The median of the duration of the surgical procedure until adenoma excision was 35.0 min (IQR 38.8), while the median duration of the entire procedure was 74.5 min (IQR 40.5). This difference in medians is statistically significant using the Wilcoxon non-parametric test for paired samples (p < 0.001). The average wait for ioPTH results post-excision was 37 min (SD ± 12.2). Three fluorescence patterns were identified: "cap" (46%), heterogeneous (30%), and homogeneous (24%). Conclusions: If preoperative imaging confirms PA location, NIFI could replace ioPTH reducing surgical time without compromising success rates.
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Affiliation(s)
- Pietro Indelicato
- Otorhinolaryngology Unit, Division of Head and Neck Department, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Diego Barbieri
- Otorhinolaryngology Unit, Division of Head and Neck Department, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Emilio Salerno
- Otorhinolaryngology Unit, Division of Head and Neck Department, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Alberto Tettamanti
- Otorhinolaryngology Unit, Division of Head and Neck Department, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Mathilda Tersilla Guizzardi
- Otorhinolaryngology Unit, Division of Head and Neck Department, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Andrea Galli
- Otorhinolaryngology Unit, Division of Head and Neck Department, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Francesco Frattini
- Division of Surgery, Istituto Auxologico Italiano IRCCS, 20145 Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Leone Giordano
- Otorhinolaryngology Unit, Division of Head and Neck Department, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Mario Bussi
- Otorhinolaryngology Unit, Division of Head and Neck Department, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Gianlorenzo Dionigi
- Division of Surgery, Istituto Auxologico Italiano IRCCS, 20145 Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
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Arikan M, Hargitai L, Binter T, Scheuba C, Riss P. In-vivo and ex-vivo parathyroid autofluorescence overlay imaging is equally feasible using two different wavelengths (785 nm vs. 805 nm). Curr Probl Surg 2024; 61:101443. [PMID: 38462311 DOI: 10.1016/j.cpsurg.2024.101443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 12/21/2023] [Accepted: 01/18/2024] [Indexed: 03/12/2024]
Affiliation(s)
- M Arikan
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria.
| | - L Hargitai
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - T Binter
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - C Scheuba
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - P Riss
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
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Yuan Y, Li X, Bao X, Huangfu M, Zhang H. The magic mirror: a novel intraoperative monitoring method for parathyroid glands. Front Endocrinol (Lausanne) 2023; 14:1160902. [PMID: 37284221 PMCID: PMC10239973 DOI: 10.3389/fendo.2023.1160902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/01/2023] [Indexed: 06/08/2023] Open
Abstract
The accurate detection of parathyroid glands (PGs) during surgery is of great significance in thyroidectomy and parathyroidectomy, which protects the function of normal PGs to prevent postoperative hypoparathyroidism and the thorough removal of parathyroid lesions. Existing conventional imaging techniques have certain limitations in the real-time exploration of PGs. In recent years, a new, real-time, and non-invasive imaging system known as the near-infrared autofluorescence (NIRAF) imaging system has been developed to detect PGs. Several studies have confirmed that this system has a high parathyroid recognition rate and can reduce the occurrence of transient hypoparathyroidism after surgery. The NIRAF imaging system, like a magic mirror, can monitor the PGs during surgery in real time, thus providing great support for surgeries. In addition, the NIRAF imaging system can evaluate the blood supply of PGs by utilizing indocyanine green (ICG) to guide surgical strategies. The NIRAF imaging system and ICG complement each other to protect normal parathyroid function and reduce postoperative complications. This article reviews the effectiveness of the NIRAF imaging system in thyroidectomies and parathyroidectomies and briefly discusses some existing problems and prospects for the future.
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Barbieri D, Melegatti MN, Vinciguerra A, Indelicato P, Giordano L, Bondi S, Biafora M, Trimarchi M, Bussi M. The use of near-infrared autofluorescence during total laryngectomy with hemi- or total thyroidectomy. Eur Arch Otorhinolaryngol 2023; 280:365-371. [PMID: 35920893 DOI: 10.1007/s00405-022-07584-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/29/2022] [Indexed: 01/19/2023]
Abstract
PURPOSE The aim of this study is to describe the use of near-infrared autofluorescence (NIR-AF) to identify and preserve parathyroid glands (PGs) in a group of patients with advanced hypopharyngeal/laryngeal cancer undergone total (pharyngo)laryngectomy with hemi- or total thyroidectomy. METHODS At San Raffaele Hospital, Milan (Italy), from January 2021 to May 2021, 7 patients affected by cT4a laryngeal squamous cell carcinoma (SCC) underwent surgery using an autofluorescence detection system (Fluobeam-Fluoptics®). For proper surgical planning, the demolition phase envisaged extension of the intervention to 4 hemithyroidectomies and 3 total thyroidectomies associated, respectively, with homolateral or bilateral CCND. Serum calcium, ionized calcium, and parathyroid hormone (PTH) levels at post-operative day (POD) 1 and 2 and at 2 weeks after surgery were monitored. Finally, we compared the data obtained with a cohort of patients who underwent surgery without the adoption of NIR-AF. RESULTS With the use of NIR-AF, 18/20 PGs were identified, of which 7/18 were preserved exclusively thanks to the use of autoflorescence. The technique also made it possible to identify and isolate three PGs from the surgical specimen, which were subsequently transplanted only after intraoperative histological confirmation. On POD-1, 3/7 patients (42.8%) were hypocalcemic; on POD-2 and after 2 weeks only 1/7 patient (14.2%) was hypocalcemic. Comparing the two groups, we highlighted that the utilization of NIR-AF was related to a significant decrease of median serum (p = 0.026) and ionized calcium levels (p = 0.017) 2 weeks after surgery. Using this new technology, in no case did definitive histological examination reveal the presence of PGs in the surgical specimen, reaching an accuracy of 100%. CONCLUSIONS In our cohort of patients who underwent total (pharyngo)laryngectomy with hemi- or total thyroidectomy, the use of near-infrared autofluorescence improved medium term postoperative hypocalcemia rates. This new technology helps to achieve a better calcemic outcome compared to the standard naked eye approach, since it helps the surgeon to identify and preserve parathyroid glandular tissue with a lower incidence of post-operative hypocalcemia.
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Affiliation(s)
- Diego Barbieri
- Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Michela Nicole Melegatti
- Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy. .,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy. .,Division of Otolaryngology, Department of Surgical Sciences, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Via Olgettina, 60, 20133, Milan, Italy.
| | | | - Pietro Indelicato
- Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Leone Giordano
- Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Bondi
- Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS Candiolo Cancer Institute, Turin, Italy
| | - Matteo Biafora
- Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Trimarchi
- Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Mario Bussi
- Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
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Dip F, Alesina PF, Anuwong A, Arora E, Berber E, Bonnin-Pascual J, Bouvy ND, Demarchi MS, Falco J, Hallfeldt K, Lee KD, Lyden ML, Maser C, Moore E, Papavramidis T, Phay J, Rodriguez JM, Seeliger B, Solórzano CC, Triponez F, Vahrmeijer A, Rosenthal RJ, White KP, Bouvet M. Use of fluorescence imaging and indocyanine green during thyroid and parathyroid surgery: Results of an intercontinental, multidisciplinary Delphi survey. Surgery 2022; 172:S6-S13. [PMID: 36427932 DOI: 10.1016/j.surg.2022.09.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 08/19/2022] [Accepted: 09/02/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND In recent years, fluorescence imaging-relying both on parathyroid gland autofluorescence under near-infrared light and angiography using the fluorescent dye indocyanine green-has been used to reduce risk of iatrogenic parathyroid injury during thyroid and parathyroid resections, but no published guidelines exist regarding its use. In this study, orchestrated by the International Society for Fluorescence Guided Surgery, areas of consensus and nonconsensus were examined among international experts to facilitate future drafting of such guidelines. METHODS A 2-round, online Delphi survey was conducted of 10 international experts in fluorescence imaging use during endocrine surgery, asking them to vote on 75 statements divided into 5 modules: 1 = patient preparation and contraindications to fluorescence imaging (n = 11 statements); 2 = technical logistics (n = 16); 3 = indications (n = 21); 4 = potential advantages and disadvantages of fluorescence imaging (n = 20); and 5 = training and research (n = 7). Several methodological steps were taken to minimize voter bias. RESULTS Overall, parathyroid autofluorescence was considered better than indocyanine green angiography for localizing parathyroid glands, whereas indocyanine green angiography was deemed superior assessing parathyroid perfusion. Additional surgical scenarios where indocyanine green angiography was thought to facilitate surgery are (1) when >1 parathyroid gland requires resection; (2) during redo surgeries, (3) facilitating parathyroid autoimplantation; and (4) for the predissection visualization of abnormal glands. Both parathyroid autofluorescence and indocyanine green angiography can be used during the same procedure and employing the same imaging equipment. However, further research is needed to optimize the dose and timing of indocyanine green administration. CONCLUSION Though further research remains necessary, using fluorescence imaging appears to have uses during thyroid and parathyroid surgery.
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Affiliation(s)
- Fernando Dip
- Instituto Argentino de Diagnóstico y Tratamiento, Buenos Aires, Argentina; Cleveland Clinic Florida, Weston, FL.
| | | | | | - Eham Arora
- Grant Medical College and Sir JJ Group of Hospitals, Mumbai, India
| | | | | | | | | | - Jorge Falco
- University Hospital Das Clinicas, Buenos Aires, Argentina
| | - Klaus Hallfeldt
- Klinikum der Ludwig-Maximilians-Universität München, Germany
| | | | | | | | - Edwina Moore
- Peninsula Private Hospital, Frankston Melbourne, Australia
| | | | | | | | | | | | | | | | | | - Kevin P White
- ScienceRight Research Consultations, Inc, London, Ontario, Canada
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Heterogeneity in Utilization of Optical Imaging Guided Surgery for Identifying or Preserving the Parathyroid Glands—A Meta-Narrative Review. Life (Basel) 2022; 12:life12030388. [PMID: 35330139 PMCID: PMC8955594 DOI: 10.3390/life12030388] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/01/2022] [Accepted: 03/06/2022] [Indexed: 12/02/2022] Open
Abstract
Background: Postoperative hypoparathyroidism is the most common complication after total thyroidectomy. Over the past years, optical imaging techniques, such as parathyroid autofluorescence, indocyanine green (ICG) angiography, and laser speckle contrast imaging (LSCI) have been employed to save parathyroid glands during thyroid surgery. This study provides an overview of the utilized methods of the optical imaging techniques during total thyroidectomy for parathyroid gland identification and preservation. Methods: PUBMED, EMBASE and Web of Science were searched for studies written in the English language utilizing parathyroid autofluorescence, ICG-angiography, or LSCI during total thyroidectomy to support parathyroid gland identification or preservation. Case reports, reviews, meta-analyses, animal studies, and post-mortem studies were excluded after the title and abstract screening. The data of the studies were analyzed qualitatively, with a focus on the methodologies employed. Results: In total, 59 articles were included with a total of 6190 patients. Overall, 38 studies reported using parathyroid autofluorescence, 24 using ICG-angiography, and 2 using LSCI. The heterogeneity between the utilized methodology in the studies was large, and in particular, regarding study protocols, imaging techniques, and the standardization of the imaging protocol. Conclusion: The diverse application of optical imaging techniques and a lack of standardization and quantification leads to heterogeneous conclusions regarding their clinical value. Worldwide consensus on imaging protocols is needed to establish the clinical utility of these techniques for parathyroid gland identification and preservation.
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