Elsevier

Surgery

Volume 154, Issue 6, December 2013, Pages 1371-1377
Surgery

American Association of Endocrine Surgeon
A novel optical approach to intraoperative detection of parathyroid glands

https://doi.org/10.1016/j.surg.2013.06.046Get rights and content

Background

Inadvertent removal of parathyroid glands is a challenge in endocrine operations. There is a critical need for a diagnostic tool that provides sensitive, real-time parathyroid detection during procedures. We have developed an intraoperative technique using near-infrared (NIR) fluorescence for in vivo, real-time detection of the parathyroid regardless of its pathologic state.

Methods

NIR fluorescence was measured intraoperatively from 45 patients undergoing parathyroidectomy and thyroidectomy. Spectra were measured from the parathyroid and surrounding neck tissues during the operation with the use of a portable, probe-based fluorescence system at 785-nm excitation. Accuracy was evaluated by comparison with histology or visual recognition by the surgeon.

Results

NIR fluorescence detected the parathyroid in 100% of patients. Parathyroid fluorescence was stronger (1.2–18 times) than that of the thyroid with peak fluorescence at 822 nm. Surrounding tissues showed no auto-fluorescence. Disease state did not affect the ability to discriminate parathyroid glands but may account for signal variability.

Conclusion

NIR fluorescence spectroscopy can detect intraoperatively the parathyroid regardless of tissue pathology. The signal may be caused by calcium-sensing receptors present in the parathyroid. The signal strength and consistency indicates the simplicity and effectiveness of this method. Its implementation may limit operative time, decrease costs, and improve operative success rates.

Section snippets

Patients and methods

Patients with primary thyroid or parathyroid disease undergoing parathyroidectomy or thyroidectomy at the Vanderbilt Endocrine Surgery Center were considered for this study. The operating endocrine surgeon determined the eligibility of each patient by evaluating their overall health in a preoperative assessment at the Vanderbilt Clinic. Under the approval of the Institutional Review board, written consent was obtained for a total of 45 patients between the ages of 18 and 99, regardless of sex

Results

The goal of this study was to determine whether NIR fluorescence spectroscopy could distinguish the parathyroid gland from the thyroid and all other tissues in the neck during surgery, regardless of disease type Fluorescence spectra of these tissues were obtained from 45 patients. Of these patients, 14 (31%) underwent thyroidectomy for benign thyroid disease, 6 (13%) underwent thyroidectomy for malignant disease, 9 (20%) underwent thyroidectomy for hyperthyroidism, and 16 (36%) underwent

Discussion

We present a novel tool that uses the intrinsic NIR autofluorescence to detect parathyroid tissue and guide surgeons in real-time during endocrine surgeries. The results reported here show that NIR fluorescence spectroscopy is capable of reliable and repeatable detection of the parathyroid gland in patients undergoing thyroidectomy and parathyroidectomy regardless of the disease state. For all patients, parathyroid fluorescence intensity is greater than thyroid fluorescence for all patients.

Conclusions

This study presents a novel tool using NIR autofluorescence spectroscopy to detect the parathyroid gland in real time during endocrine surgeries. We have shown its ability to accurately detect the parathyroid regardless of disease state with greater sensitivity and specificity than other imaging modalities including visual diagnosis. The mechanism of the autofluorescence is still unknown, but this technique shows promise as an intraoperative tool for improving success of parathyroidectomies and

References (19)

There are more references available in the full text version of this article.

Cited by (140)

View all citing articles on Scopus

Supported by NCI 1R25CA136440-01 and NIH R41 EB015291.

a

Department of Biomedical Engineering, Vanderbilt University, Nashville, TN

b

Department of Surgery, Division of Surgical Oncology, The Ohio State University, Columbus, OH

c

Section of Surgical Sciences, Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University, Nashville, TN

View full text