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StayCurrentMD
Update Course Rewind: Autofluorescence & ICG Angiography in Thyroid Surgery 2024
With Dr. Ben Ham & Dr. Justin Huntington · hosted by Dr. M. Goldy
Chapter 1 of 6 · Fundamentals
Introduction
Introduction and Classification System
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What the experts said
The interpretation of what constitutes high fluorescence is somewhat subjective
Seeing both sides of the neck simultaneously to assess parathyroid perfusion with ICG is technically difficult
The fluoptics machine is most useful for examining the surgical specimen to identify parathyroid glands that may have been inadvertently removed
Parathyroid reimplantation should be considered to reduce the risk of permanent parathyroidism, hypocalcemia, and the need for difficult-to-manage hypocalcemia in the setting of permanent severe hypoparathyroidism
When performing ICG angiography, sensitivity must be adjusted quickly or everything lights up rapidly and becomes not very useful
A new device was released within the last month with a switch to flip between autofluorescence and ICG angiography modes so that ICG does not overwhelm the autofluorescence
The technology for parathyroid identification will continue to improve and will become more mainstream
Doing more than 25 thyroid surgeries per year has been shown to improve rates of hypoparathyroidism or hypocalcemia after thyroidectomy
A randomized controlled trial from France showed that using autofluorescence to identify parathyroid glands may significantly reduce early post-operative hypocalcemia and improve parathyroid preservation after total thyroidectomy
In the French RCT, hypocalcemia rates were about half with using autofluorescence versus not using it
The need for auto transplantation was approximately one third when using autofluorescence compared to not using it
The rate of resected parathyroid glands in the specimen was about a quarter when using autofluorescence
Parathyroids naturally autofluoresce at a specific wavelength without requiring injection of any substance
ICG can be injected to assess the perfusion of parathyroid glands in addition to autofluorescence
There is no persistent hypocalcemia if you see high fluorescence of at least one parathyroid gland
Emerging imaging technologies such as autofluorescence and ICG angiography hold promise for improving gland identification and preservation, but their implementation varies and research on their effectiveness is still in the early stages
Real-life use of autofluorescence and ICG technology may not be as good as advertised in published studies