SYSTEMATIC REVIEW article
Front. Endocrinol.
Sec. Thyroid Endocrinology
This article is part of the Research TopicState of the Art Parathyroid Identification and Preservation in Thyroid and Parathyroid SurgeryView all 3 articles
Fluorescence Imaging Techniques for Parathyroid Gland Identification and Evaluation During Thyroidectomy, Combined Use of Autofluorescence and Indocyanine Green Fluorescence: A Meta Analysis
Provisionally accepted
- 1Surgical Oncology, Dharmais Hospital National Cancer Center, Jakarta, Indonesia
- 2Functional Medical Staff of Surgical Oncology, Dharmais Hospital National Cancer Center, Jakarta, Indonesia
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Background: Post-thyroidectomy hypoparathyroidism remains the most frequent complication of thyroidectomy, largely due to inadvertent parathyroid gland (PG) injury, devascularization, or misidentification. Near-infrared autofluorescence (NIRAF) enables intraoperative identification of PGs, while indocyanine green fluorescence (ICGF) allows real-time assessment of gland perfusion. This meta-analysis aimed to evaluate the efficacy of the combined use of NIRAF and ICGF in thyroidectomy. Methods: A systematic search of PubMed, Cochrane, Scopus, and ScienceDirect was conducted up to October 2025. Reported outcomes included transient hypoparathyroidism, permanent hypoparathyroidism, and number of identified PGs. Bias was evaluated using Newcastle-Ottawa Scale for cohort studies and Cochrane Risk of Bias Tool for Randomized Trials (RoB 1.0 and 2.0). Meta-analyses were performed using Review Manager (RevMan) version 5.4.1. Result: Four studies encompassing 1,127 patients were included. Meta-analysis demonstrated that combined NIRAF and ICGF significantly reduced the risk of transient hypoparathyroidism (RR 0.72; 95% CI 0.54–0.96; p = 0.02) and permanent hypoparathyroidism (RR 0.56; 95% CI 0.35–0.88; p = 0.01) compared with standard care. Additionally, the number of identified PGs was significantly higher intervention group (MD 0.33; 95% CI 0.23–0.43; p < 0.0001). The overall risk of bias across studies was rated as low to moderate. Conclusion: Combined use of NIRAF and ICGF demonstrates a significant improvement in PG identification and reduces both transient and permanent hypoparathyroidism.
Keywords: Fluorescence Imaging, Hypoparathyroidism, Indocyanine Green Fluorescence, Near-infrared autofluorescence, Parathyroid gland
Received: 08 Jan 2026; Accepted: 16 Feb 2026.
Copyright: © 2026 Soeratman, Setiadi and Brahma. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Alif Rizky Soeratman
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