TY - JOUR
T1 - Use of fluorescence imaging and indocyanine green during thyroid and parathyroid surgery
T2 - Results of an intercontinental, multidisciplinary Delphi survey
AU - Dip, Fernando
AU - Alesina, Piero Francesco
AU - Anuwong, Angkoon
AU - Arora, Eham
AU - Berber, Eren
AU - Bonnin-Pascual, Jamie
AU - Bouvy, Nicole D.
AU - Demarchi, Marco Stefano
AU - Falco, Jorge
AU - Hallfeldt, Klaus
AU - Lee, Kang Dae
AU - Lyden, Melanie L.
AU - Maser, Christina
AU - Moore, Edwina
AU - Papavramidis, Theodossis
AU - Phay, John
AU - Rodriguez, Jose M.
AU - Seeliger, Barbara
AU - Solórzano, Carmen C.
AU - Triponez, Frederic
AU - Vahrmeijer, Alexander
AU - Rosenthal, Raul J.
AU - White, Kevin P.
AU - Bouvet, Michael
N1 - Funding Information:
Fernando Dip, Jorge Falco, Alexander Vahrmeijer, Raul Rosenthal, Kevin White, and Michael Bouvet are members of the ISFGS Advisory Board. None of the industry sponsors were actively involved in any process of the Delphi consensus or drafting, review, or revision of the manuscript. All companies are sponsors/Corporate Council members of the ISFGS.
Funding Information:
Diagnostic Green; Intuitive; Medtronic; Olympus; Karl Storz; Stryker: Each provided unrestricted grants for the International Society for Fluorescence Guided Surgery (ISFGS) Advisory Board meeting, Frankfurt, Germany, September 8, 2019, during which the Delphi consensus was discussed. Diagnostic Green also funded accommodations and meals. Diagnostic Green, Medtronic, Karl Storz, Stryker, Arthrex, and Richard Wolf provided additional financial support to ISFGS for this publication.
Funding Information:
This article is published as part of a supplement supported by the International Society for Fluorescence Guided Surgery (ISFGS) with funding from Arthrex, Diagnostic Green, Intuitive, Medtronic, Olympus, Karl Storz Endoscopy, Stryker, and Richard Wolf.
Publisher Copyright:
© 2022
PY - 2022/12/1
Y1 - 2022/12/1
N2 - 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.
AB - 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.
U2 - 10.1016/j.surg.2022.09.004
DO - 10.1016/j.surg.2022.09.004
M3 - Article
C2 - 36427932
SN - 0039-6060
VL - 172
SP - S6-S13
JO - Surgery
JF - Surgery
IS - 6
ER -