State of the Art Parathyroid Identification and Preservation in Thyroid and Parathyroid Surgery

Thyroid and parathyroid surgery is a common and safe surgery with very few complications. However, permanent postoperative hypocalcemia (greater than 6 months) can have a significant influence on the quality of life in patients and require a lifetime of calcium replacement. Inadvertent removal of a parathyroid gland or devascularization of the gland can occur despite careful dissection, even in experienced hands. Surgical experience aids with the identification and visualization of these small glands, but in certain situations, the parathyroid glands may not be well localization particularly in revision surgery or in patients with thyroid cancer. The standard approach to inadvertent parathyroid gland removal is to morselize and autotransplant the fragments of the parathyroid gland into the sternocleidomastoid muscle or infrahyoid strap muscles. However, there are situations where the gland is not identified. To improve the rates of hypocalcemia postoperatively, technological advancements have been developed to assist surgeons in the intraoperative localization of these small glands.

The goal of our special issue is to provide a consortium from the various endocrine surgeons from around the world on the different technological approaches for detecting parathyroid glands. Due to the growing body of literature surrounding Near Infrared Autofluorescence (NIRAF) technology as well as emerging approaches that aim to improve the rates of post-operative hypocalcemia, we are seeking expert surgeons’ opinions who have used this technology and their intuitional experiences.

• Near-infrared autofluorescence vs visualization of parathyroids
• Camera vs probe technique for Near Infrared Autofluorescence
• Near-infrared autofluorescence patterns of hyperplastic parathyroids vs single adenomas
• Near-infrared autofluorescence imaging-based detection using deep learning
• Approaches for quantifying autofluorescence of parathyroid glands, with and/or without artificial intelligence
• Near-infrared autofluorescence patterns in pediatric vs adult patients
• The use and benefit of Indocyanine green (ICG) for parathyroid identification
• The learning curve associated with implementing NIRAF techniques
• The use of augmented reality glasses for identifying parathyroid glands
• The use of intraoperative PTH assay vs near-infrared autofluorescence technology