Autofluorescence of Parathyroid Glands: A Review of Methods of Parathyroid Gland Identification and Parathyroid Vascular Assessment

Amanda Silver Karcioglu; Dana Hartl; David C Shonka Jr; Cristian M Slough; Brendan C Stack Jr; Neil Tolley; Amr H Abdelhamid Ahmed; Gregory W Randolph

doi:10.1016/j.otc.2023.07.011

Autofluorescence of Parathyroid Glands: A Review of Methods of Parathyroid Gland Identification and Parathyroid Vascular Assessment

Otolaryngol Clin North Am. 2024 Feb;57(1):139-154. doi: 10.1016/j.otc.2023.07.011. Epub 2023 Aug 25.

Authors

Amanda Silver Karcioglu¹, Dana Hartl², David C Shonka Jr³, Cristian M Slough⁴, Brendan C Stack Jr⁵, Neil Tolley⁶, Amr H Abdelhamid Ahmed⁷, Gregory W Randolph⁸

Affiliations

¹ Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, NorthShore University HealthSystem, 9669 North Kenton Avenue, Suite 206, Skokie, IL 60076, USA. Electronic address: akarcioglu@northshore.org.
² Department of Surgery, Thyroid Surgery Unit, Gustave Roussy Cancer Campus and University Paris-Saclay, 114 rue Edouard Vaillant, Villejuif, Paris 94805, France.
³ Division of Head and Neck Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Virginia, PO Box 800713, Charlottesville, VA 22903, USA.
⁴ Department of Otolaryngology-Head and Neck Surgery, Hawke's Bay Fallen Soldiers' Memorial Hospital, Te Whatu Ora Health New Zealand, 251 Orchard Road, Frimley, Hastings 4120, New Zealand.
⁵ Department of Otolaryngology-Head and Neck Surgery, Hawke's Bay Fallen Soldiers' Memorial Hospital, Te Whatu Ora Health New Zealand, 251 Orchard Road, Frimley, Hastings 4120, New Zealand; Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, PO Box 19662, Springfield, IL 62794-9662, USA.
⁶ Department Otolaryngology-Head & Neck Surgery, St Mary's Hospital, Imperial College NHS Healthcare Trust, Praed Street, Paddington, London W2 1NY, UK.
⁷ Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA.
⁸ Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA; Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.

PMID: 37634981
DOI: 10.1016/j.otc.2023.07.011

Abstract

Postoperative hypoparathyroidism may cause significant patient morbidity and even mortality. Emerging technologies centered on autofluorescent properties of parathyroid glands when exposed to near-infrared light hold promise to improve surgical parathyroid gland identification and preservation. Two systems (probe-based and camera-based) are commercially available currently; however, neither system alone provides indication of vascular viability or postoperative parathyroid gland function. The administration of indocyanine green, when combined with near-infrared fluorescence imaging, enables subjective assessment of parathyroid gland perfusion. Additional technologies to assess parathyroid gland perfusion are being developed. The impact of these nascent technologies on relevant clinical outcomes is an area of active investigation.

Keywords: Hypoparathyroidism; Indocyanine green; Laser speckle; Near-infrared autofluorescence; Parathyroid gland; Thyroid surgery.

Publication types

Review

MeSH terms

Humans
Hypoparathyroidism* / diagnosis
Hypoparathyroidism* / etiology
Hypoparathyroidism* / surgery
Indocyanine Green
Optical Imaging / adverse effects
Optical Imaging / methods
Parathyroid Glands* / diagnostic imaging
Parathyroid Glands* / surgery
Thyroidectomy / adverse effects

Substances

Indocyanine Green