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
- Institución
- Consejo Nacional de Investigaciones Científicas y Técnicas
- OAI Identificador
- oai:ri.conicet.gov.ar:11336/109424
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oai:ri.conicet.gov.ar:11336/109424 |
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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 Técnicas2025-09-29T09:49:57Zoai: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:34982025-09-29 09:49:57.42CONICET 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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1844613542805766144 |
score |
13.070432 |