A Randomized, Controlled Trial Comparing White-Light with Near-Infrared Autofluorescence for Parathyroid Gland Identification during Total Thyroidectomy

Autores
Dip, Fernando; Falco, Jorge; Verna, Silvina; Prunello, Marcos Miguel; Loccisano, Matias; Quadri, Pablo; White, Kevin; Rosenthal, Raul
Año de publicación
2019
Idioma
inglés
Tipo de recurso
artículo
Estado
versión publicada
Descripción
Background: Parathyroid glands are difficult to identify during total thyroidectomies and accidental resection can lead to problematic post-operative hypocalcemia. Our main goals were to evaluate the effectiveness of using near-infrared light (NIRL) auto-fluorescence intra-operatively for parathyroid-gland identification; and to measure its impact on postoperative hypocalcemia incidence.Study Design Total thyroidectomies were performed on 170 patients with different thyroid pathologies, block-randomized (1:1) into 2 equal groups. Among controls, traditional overhead white light (WL) was used throughout. In the experimental group, NIRL was used to enhance parathyroid gland recognition before thyroid dissection. The number of parathyroid glands identified was compared after thyroid dissection in controls using WL vs pre-dissection in the experimental using NIRL and with WL vs NIRL before thyroid dissection in the experimental group. Postoperative serum calcium levels and hypocalcemia rates were compared. Results: The mean number of parathyroid glands identified pre-dissection with NIRL was the same identified post-dissection with WL (3.5 vs 3.6). In the experimental group, converting from WL to NIRL increased the number of glands detected from 2.6 to 3.5 (p < 0.001), and revealed at least 1 previously missed gland in 67.1% of patients. Calcium levels ≤7.5 mg/dL were one-tenth as common in the NIRL group (p = 0.005). The adjusted odds of hypocalcemia developing increased by 15% for every 5-g increase in thyroid gland weight (odds ratio 1.15; 95% CI 1.06 to 1.25). All hypocalcemia resolved within 6 months. Conclusions: Using NIRL during thyroidectomy increases intraoperative identification of parathyroid glands, enhances their detection before thyroid dissection, and decreases the incidence of postoperative hypocalcemia.
Fil: Dip, Fernando. instituto Argentino de Diagnóstico y Tratamiento; Argentina
Fil: Falco, Jorge. Instituto Argentino de Diagnóstico y Tratamiento; Argentina
Fil: Verna, Silvina. Instituto Argentino de Diagnóstico y Tratamiento; Argentina
Fil: Prunello, Marcos Miguel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Rosario; Argentina. Universidad Nacional de Rosario. Facultad de Cs.bioquimicas y Farmaceuticas. Departamento de Matematica y Estadistica.; Argentina
Fil: Loccisano, Matias. Instituto Argentino de Diagnóstico y Tratamiento; Argentina
Fil: Quadri, Pablo. Instituto Argentino de Diagnóstico y Tratamiento; Argentina
Fil: White, Kevin. Scienceright Research Consultations; Canadá
Fil: Rosenthal, Raul. Cleveland Clinic Florida; Estados Unidos
Materia
HYPOCALCEMIA
IMAGING
NEAR-INFRARED LIGHT
PARATHYROID
THYROIDECTOMY
Nivel de accesibilidad
acceso abierto
Condiciones de uso
https://creativecommons.org/licenses/by-nc-sa/2.5/ar/
Repositorio
CONICET Digital (CONICET)
Institución
Consejo Nacional de Investigaciones Científicas y Técnicas
OAI Identificador
oai:ri.conicet.gov.ar:11336/109424
Acceder
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oai_identifier_str oai:ri.conicet.gov.ar:11336/109424
network_acronym_str CONICETDig
repository_id_str 3498
network_name_str CONICET Digital (CONICET)
spelling A Randomized, Controlled Trial Comparing White-Light with Near-Infrared Autofluorescence for Parathyroid Gland Identification during Total ThyroidectomyDip, FernandoFalco, JorgeVerna, SilvinaPrunello, Marcos MiguelLoccisano, MatiasQuadri, PabloWhite, KevinRosenthal, RaulHYPOCALCEMIAIMAGINGNEAR-INFRARED LIGHTPARATHYROIDTHYROIDECTOMYhttps://purl.org/becyt/ford/3.3https://purl.org/becyt/ford/3Background: Parathyroid glands are difficult to identify during total thyroidectomies and accidental resection can lead to problematic post-operative hypocalcemia. Our main goals were to evaluate the effectiveness of using near-infrared light (NIRL) auto-fluorescence intra-operatively for parathyroid-gland identification; and to measure its impact on postoperative hypocalcemia incidence.Study Design Total thyroidectomies were performed on 170 patients with different thyroid pathologies, block-randomized (1:1) into 2 equal groups. Among controls, traditional overhead white light (WL) was used throughout. In the experimental group, NIRL was used to enhance parathyroid gland recognition before thyroid dissection. The number of parathyroid glands identified was compared after thyroid dissection in controls using WL vs pre-dissection in the experimental using NIRL and with WL vs NIRL before thyroid dissection in the experimental group. Postoperative serum calcium levels and hypocalcemia rates were compared. Results: The mean number of parathyroid glands identified pre-dissection with NIRL was the same identified post-dissection with WL (3.5 vs 3.6). In the experimental group, converting from WL to NIRL increased the number of glands detected from 2.6 to 3.5 (p < 0.001), and revealed at least 1 previously missed gland in 67.1% of patients. Calcium levels ≤7.5 mg/dL were one-tenth as common in the NIRL group (p = 0.005). The adjusted odds of hypocalcemia developing increased by 15% for every 5-g increase in thyroid gland weight (odds ratio 1.15; 95% CI 1.06 to 1.25). All hypocalcemia resolved within 6 months. Conclusions: Using NIRL during thyroidectomy increases intraoperative identification of parathyroid glands, enhances their detection before thyroid dissection, and decreases the incidence of postoperative hypocalcemia.Fil: Dip, Fernando. instituto Argentino de Diagnóstico y Tratamiento; ArgentinaFil: Falco, Jorge. Instituto Argentino de Diagnóstico y Tratamiento; ArgentinaFil: Verna, Silvina. Instituto Argentino de Diagnóstico y Tratamiento; ArgentinaFil: Prunello, Marcos Miguel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Rosario; Argentina. Universidad Nacional de Rosario. Facultad de Cs.bioquimicas y Farmaceuticas. Departamento de Matematica y Estadistica.; ArgentinaFil: Loccisano, Matias. Instituto Argentino de Diagnóstico y Tratamiento; ArgentinaFil: Quadri, Pablo. Instituto Argentino de Diagnóstico y Tratamiento; ArgentinaFil: White, Kevin. Scienceright Research Consultations; CanadáFil: Rosenthal, Raul. Cleveland Clinic Florida; Estados UnidosElsevier Science Inc2019-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttp://purl.org/coar/resource_type/c_6501info:ar-repo/semantics/articuloapplication/pdfapplication/pdfhttp://hdl.handle.net/11336/109424Dip, Fernando; Falco, Jorge; Verna, Silvina; Prunello, Marcos Miguel; Loccisano, Matias; et al.; A Randomized, Controlled Trial Comparing White-Light with Near-Infrared Autofluorescence for Parathyroid Gland Identification during Total Thyroidectomy; Elsevier Science Inc; Journal Of The American College Of Surgeons; 228; 5; 1-2019; 744-7511072-7515CONICET DigitalCONICETenginfo:eu-repo/semantics/altIdentifier/url/https://linkinghub.elsevier.com/retrieve/pii/S107275151930081Xinfo:eu-repo/semantics/altIdentifier/doi/10.1016/j.jamcollsurg.2018.12.044info:eu-repo/semantics/openAccesshttps://creativecommons.org/licenses/by-nc-sa/2.5/ar/reponame:CONICET Digital (CONICET)instname:Consejo Nacional de Investigaciones Científicas y Técnicas2025-10-22T11:19:17Zoai:ri.conicet.gov.ar:11336/109424instacron:CONICETInstitucionalhttp://ri.conicet.gov.ar/Organismo científico-tecnológicoNo correspondehttp://ri.conicet.gov.ar/oai/requestdasensio@conicet.gov.ar; lcarlino@conicet.gov.arArgentinaNo correspondeNo correspondeNo correspondeopendoar:34982025-10-22 11:19:18.124CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicasfalse
dc.title.none.fl_str_mv A Randomized, Controlled Trial Comparing White-Light with Near-Infrared Autofluorescence for Parathyroid Gland Identification during Total Thyroidectomy
title A Randomized, Controlled Trial Comparing White-Light with Near-Infrared Autofluorescence for Parathyroid Gland Identification during Total Thyroidectomy
spellingShingle A Randomized, Controlled Trial Comparing White-Light with Near-Infrared Autofluorescence for Parathyroid Gland Identification during Total Thyroidectomy
Dip, Fernando
HYPOCALCEMIA
IMAGING
NEAR-INFRARED LIGHT
PARATHYROID
THYROIDECTOMY
title_short A Randomized, Controlled Trial Comparing White-Light with Near-Infrared Autofluorescence for Parathyroid Gland Identification during Total Thyroidectomy
title_full A Randomized, Controlled Trial Comparing White-Light with Near-Infrared Autofluorescence for Parathyroid Gland Identification during Total Thyroidectomy
title_fullStr A Randomized, Controlled Trial Comparing White-Light with Near-Infrared Autofluorescence for Parathyroid Gland Identification during Total Thyroidectomy
title_full_unstemmed A Randomized, Controlled Trial Comparing White-Light with Near-Infrared Autofluorescence for Parathyroid Gland Identification during Total Thyroidectomy
title_sort A Randomized, Controlled Trial Comparing White-Light with Near-Infrared Autofluorescence for Parathyroid Gland Identification during Total Thyroidectomy
dc.creator.none.fl_str_mv Dip, Fernando
Falco, Jorge
Verna, Silvina
Prunello, Marcos Miguel
Loccisano, Matias
Quadri, Pablo
White, Kevin
Rosenthal, Raul
author Dip, Fernando
author_facet Dip, Fernando
Falco, Jorge
Verna, Silvina
Prunello, Marcos Miguel
Loccisano, Matias
Quadri, Pablo
White, Kevin
Rosenthal, Raul
author_role author
author2 Falco, Jorge
Verna, Silvina
Prunello, Marcos Miguel
Loccisano, Matias
Quadri, Pablo
White, Kevin
Rosenthal, Raul
author2_role author
author
author
author
author
author
author
dc.subject.none.fl_str_mv HYPOCALCEMIA
IMAGING
NEAR-INFRARED LIGHT
PARATHYROID
THYROIDECTOMY
topic HYPOCALCEMIA
IMAGING
NEAR-INFRARED LIGHT
PARATHYROID
THYROIDECTOMY
purl_subject.fl_str_mv https://purl.org/becyt/ford/3.3
https://purl.org/becyt/ford/3
dc.description.none.fl_txt_mv Background: Parathyroid glands are difficult to identify during total thyroidectomies and accidental resection can lead to problematic post-operative hypocalcemia. Our main goals were to evaluate the effectiveness of using near-infrared light (NIRL) auto-fluorescence intra-operatively for parathyroid-gland identification; and to measure its impact on postoperative hypocalcemia incidence.Study Design Total thyroidectomies were performed on 170 patients with different thyroid pathologies, block-randomized (1:1) into 2 equal groups. Among controls, traditional overhead white light (WL) was used throughout. In the experimental group, NIRL was used to enhance parathyroid gland recognition before thyroid dissection. The number of parathyroid glands identified was compared after thyroid dissection in controls using WL vs pre-dissection in the experimental using NIRL and with WL vs NIRL before thyroid dissection in the experimental group. Postoperative serum calcium levels and hypocalcemia rates were compared. Results: The mean number of parathyroid glands identified pre-dissection with NIRL was the same identified post-dissection with WL (3.5 vs 3.6). In the experimental group, converting from WL to NIRL increased the number of glands detected from 2.6 to 3.5 (p < 0.001), and revealed at least 1 previously missed gland in 67.1% of patients. Calcium levels ≤7.5 mg/dL were one-tenth as common in the NIRL group (p = 0.005). The adjusted odds of hypocalcemia developing increased by 15% for every 5-g increase in thyroid gland weight (odds ratio 1.15; 95% CI 1.06 to 1.25). All hypocalcemia resolved within 6 months. Conclusions: Using NIRL during thyroidectomy increases intraoperative identification of parathyroid glands, enhances their detection before thyroid dissection, and decreases the incidence of postoperative hypocalcemia.
Fil: Dip, Fernando. instituto Argentino de Diagnóstico y Tratamiento; Argentina
Fil: Falco, Jorge. Instituto Argentino de Diagnóstico y Tratamiento; Argentina
Fil: Verna, Silvina. Instituto Argentino de Diagnóstico y Tratamiento; Argentina
Fil: Prunello, Marcos Miguel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Rosario; Argentina. Universidad Nacional de Rosario. Facultad de Cs.bioquimicas y Farmaceuticas. Departamento de Matematica y Estadistica.; Argentina
Fil: Loccisano, Matias. Instituto Argentino de Diagnóstico y Tratamiento; Argentina
Fil: Quadri, Pablo. Instituto Argentino de Diagnóstico y Tratamiento; Argentina
Fil: White, Kevin. Scienceright Research Consultations; Canadá
Fil: Rosenthal, Raul. Cleveland Clinic Florida; Estados Unidos
description Background: Parathyroid glands are difficult to identify during total thyroidectomies and accidental resection can lead to problematic post-operative hypocalcemia. Our main goals were to evaluate the effectiveness of using near-infrared light (NIRL) auto-fluorescence intra-operatively for parathyroid-gland identification; and to measure its impact on postoperative hypocalcemia incidence.Study Design Total thyroidectomies were performed on 170 patients with different thyroid pathologies, block-randomized (1:1) into 2 equal groups. Among controls, traditional overhead white light (WL) was used throughout. In the experimental group, NIRL was used to enhance parathyroid gland recognition before thyroid dissection. The number of parathyroid glands identified was compared after thyroid dissection in controls using WL vs pre-dissection in the experimental using NIRL and with WL vs NIRL before thyroid dissection in the experimental group. Postoperative serum calcium levels and hypocalcemia rates were compared. Results: The mean number of parathyroid glands identified pre-dissection with NIRL was the same identified post-dissection with WL (3.5 vs 3.6). In the experimental group, converting from WL to NIRL increased the number of glands detected from 2.6 to 3.5 (p < 0.001), and revealed at least 1 previously missed gland in 67.1% of patients. Calcium levels ≤7.5 mg/dL were one-tenth as common in the NIRL group (p = 0.005). The adjusted odds of hypocalcemia developing increased by 15% for every 5-g increase in thyroid gland weight (odds ratio 1.15; 95% CI 1.06 to 1.25). All hypocalcemia resolved within 6 months. Conclusions: Using NIRL during thyroidectomy increases intraoperative identification of parathyroid glands, enhances their detection before thyroid dissection, and decreases the incidence of postoperative hypocalcemia.
publishDate 2019
dc.date.none.fl_str_mv 2019-01
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
http://purl.org/coar/resource_type/c_6501
info:ar-repo/semantics/articulo
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/11336/109424
Dip, Fernando; Falco, Jorge; Verna, Silvina; Prunello, Marcos Miguel; Loccisano, Matias; et al.; A Randomized, Controlled Trial Comparing White-Light with Near-Infrared Autofluorescence for Parathyroid Gland Identification during Total Thyroidectomy; Elsevier Science Inc; Journal Of The American College Of Surgeons; 228; 5; 1-2019; 744-751
1072-7515
CONICET Digital
CONICET
url http://hdl.handle.net/11336/109424
identifier_str_mv Dip, Fernando; Falco, Jorge; Verna, Silvina; Prunello, Marcos Miguel; Loccisano, Matias; et al.; A Randomized, Controlled Trial Comparing White-Light with Near-Infrared Autofluorescence for Parathyroid Gland Identification during Total Thyroidectomy; Elsevier Science Inc; Journal Of The American College Of Surgeons; 228; 5; 1-2019; 744-751
1072-7515
CONICET Digital
CONICET
dc.language.none.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv info:eu-repo/semantics/altIdentifier/url/https://linkinghub.elsevier.com/retrieve/pii/S107275151930081X
info:eu-repo/semantics/altIdentifier/doi/10.1016/j.jamcollsurg.2018.12.044
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
https://creativecommons.org/licenses/by-nc-sa/2.5/ar/
eu_rights_str_mv openAccess
rights_invalid_str_mv https://creativecommons.org/licenses/by-nc-sa/2.5/ar/
dc.format.none.fl_str_mv application/pdf
application/pdf
dc.publisher.none.fl_str_mv Elsevier Science Inc
publisher.none.fl_str_mv Elsevier Science Inc
dc.source.none.fl_str_mv reponame:CONICET Digital (CONICET)
instname:Consejo Nacional de Investigaciones Científicas y Técnicas
reponame_str CONICET Digital (CONICET)
collection CONICET Digital (CONICET)
instname_str Consejo Nacional de Investigaciones Científicas y Técnicas
repository.name.fl_str_mv CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicas
repository.mail.fl_str_mv dasensio@conicet.gov.ar; lcarlino@conicet.gov.ar
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score 12.982451

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