Use of fluorescence imaging and indocyanine green during thyroid and parathyroid surgery: Results of an intercontinental, multidisciplinary Delphi survey
Year: 2022
Type: article
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.
Source: Surgery
Authors: Fernando Dip, Piero Francesco Alesina, Angkoon Anuwong, Eham Arora, Eren Berber, Jamie Bonnin-Pascual, Nicole D. Bouvy, Marco Stefano Demarchi, Jorge Falco, Klaus Hallfeldt, Kang Dae Lee, Melanie L. Lyden, Christina Maser, Edwina Moore, Theodossis Papavramidis, John Phay, Jose M. Rodriguez, Barbara Seeliger, Carmen C. Solórzano, Frederic Triponez, Alexander Vahrmeijer, Raul J. Rosenthal, Kevin P. White, Michael Bouvet
Institutions: Instituto Argentino de Diagnóstico y Tratamiento, Cleveland Clinic Florida, Università Cattolica del Sacro Cuore, Police General Hospital, Grant Medical College and Sir Jamshedjee Jeejeebhoy Group of Hospitals, Cleveland Clinic, Hospital Universitario Son Espases, Maastricht University Medical Centre, University Hospital of Geneva, Ludwig-Maximilians-Universität München, Kosin University Gospel Hospital, Mayo Clinic, Central Michigan University, Frankston Hospital, Aristotle University of Thessaloniki, The Ohio State University, Hospital Universitario Virgen de la Arrixaca, Institut de Chirurgie Guidée par l'Image, Vanderbilt University Medical Center, Leiden University Medical Center, University of California San Diego
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,650
OpenAlex ID: W4309578710