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Guo H, Zhang Y, Ren S, Yang X, Tian L, Huang Y, Zhang C, Zhang X. Real-time imaging of ipsilateral parathyroid glands by retrograde injection of methylene blue into the superior thyroid artery: a new intraoperative parathyroid protection method. BMC Surg 2024; 24:108. [PMID: 38615003 PMCID: PMC11015547 DOI: 10.1186/s12893-024-02360-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/15/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Postoperative hypoparathyroidism caused by parathyroid injury is a problem faced by thyroid surgeons. The current technologies for parathyroid imaging all have some defects. METHODS Patients with differentiated thyroid carcinoma (DTC) who underwent unilateral thyroidectomy plus ipsilateral central lymph node dissection were recruited. We dissected the main trunk of the superior thyroid artery entering the thyroid gland and placed the venous indwelling tube into the artery. The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were calculated. RESULTS A total of 132 patients enrolled in this single-arm clinical trial, 105 of them completed retrograde catheterization via the superior artery. The sensitivity was 69.23 and 83.33% respectively. The specificity was 72.91 and 64.89%. The accuracy was 72.91 and 64.89%. The PPV was 85.71 and 81.08%. The NPV was 22.58 and 45.45%. There were no patients with allergic reactions to the methylene blue, or methylene blue toxicity. CONCLUSIONS Retrograde injection of methylene blue via the superior thyroid artery is an effective and safe method to visualize parathyroid glands. This method can accurately locate the target organ by ultraselecting the blood vessel and injecting the contrast agent while avoiding background contamination and reducing the amount of contrast agent. TRIAL REGISTRATION Clinical trial registration numbers and date of registration: ChiCTR2300077263、02/11/2023.
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Affiliation(s)
- Hanjie Guo
- School of Medicine, South China University of Technology, 382 Waihuan Rd E, Panyu, Guangzhou, 510006, People's Republic of China
- Department of General Surgery, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian, Beijing, 100048, People's Republic of China
| | - Yuxing Zhang
- Department of General Surgery, The First Medical Center of PLA General Hospital, 28 Fuxing Road, Haidian, Beijing, 100853, People's Republic of China
| | - Saiyu Ren
- School of Medicine, South China University of Technology, 382 Waihuan Rd E, Panyu, Guangzhou, 510006, People's Republic of China
- Department of General Surgery, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian, Beijing, 100048, People's Republic of China
| | - Xiaodong Yang
- Department of General Surgery, The First Medical Center of PLA General Hospital, 28 Fuxing Road, Haidian, Beijing, 100853, People's Republic of China
| | - Lei Tian
- Department of General Surgery, The First Medical Center of PLA General Hospital, 28 Fuxing Road, Haidian, Beijing, 100853, People's Republic of China
| | - Yun Huang
- Department of General Surgery, The First Medical Center of PLA General Hospital, 28 Fuxing Road, Haidian, Beijing, 100853, People's Republic of China
| | - Chaojun Zhang
- Department of General Surgery, The First Medical Center of PLA General Hospital, 28 Fuxing Road, Haidian, Beijing, 100853, People's Republic of China.
| | - Xiliang Zhang
- Department of General Surgery, The First Medical Center of PLA General Hospital, 28 Fuxing Road, Haidian, Beijing, 100853, People's Republic of China.
- School of Medicine, South China University of Technology, 382 Waihuan Rd E, Panyu, Guangzhou, 510006, People's Republic of China.
- Department of General Surgery, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian, Beijing, 100048, People's Republic of China.
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Saliba MB, Zhivova VA, Vetshev FP, Gabaidze DI, Efendiev KT, Udeneev AM, Pavlova EA, Shiryaev AA. [First experience of applying domestic video fluorescent equipment for visualization and blood flow evaluation of the parathyroid glands]. Khirurgiia (Mosk) 2024:71-78. [PMID: 38258691 DOI: 10.17116/hirurgia202401171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
In recent years, predictive methods for assessing the preservation of the parathyroid glands have been actively implemented. The article describes the first experience of evaluating the blood supply of the parathyroid glands by quantitative determination of the indocyanine green (ICG) accumulation index in real time in 6 patients before and after a thyroidectomy with central neck lymph node dissection for papillary thyroid cancer. Intraoperative fluorescent angiography was performed by using domestic equipment with a fluorescent module, as well as by using a domestic medication of ICG. Intraoperative values of the ICG accumulation index were compared with the levels of ionized calcium and parathyroid hormone perioperatively. No clinical manifestations of hypocalcemia were detected in the postoperative period. The obtained results showed the informativeness of the numerical assessment of the intensity of ICG fluorescence. The evaluation of the distribution (accumulation) of ICG has prospects for practical application in thyroid surgery in the formation of tactics for preserving the parathyroid glands and predicting postoperative hypoparathyreosis.
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Affiliation(s)
- M B Saliba
- Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - V A Zhivova
- Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - F P Vetshev
- Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - D I Gabaidze
- Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - K T Efendiev
- Prokhorov General Physics Institute of the Russian Academy of Sciences, Moscow, Russia
| | - A M Udeneev
- National Research Nuclear University MEPhI (Moscow Engineering Physics Institute), Moscow, Russia
| | - E A Pavlova
- Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - A A Shiryaev
- Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
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