Ladurner Roland, Sommerey Sandra, Arabi Nora Al, Hallfeldt Klaus K J, Stepp Herbert, Gallwas Julia K S
Department of Surgery, Ludwig Maximilians University Munich, Innenstadt Medical Campus, Nussbaumstrasse 20, 80336, Munich, Germany.
Laser-Research Laboratory, LIFE-Center, Ludwig Maximilians University Munich, Grosshadern Medical Campus, Feodor-Lynen-Str. 19, 81377, Munich, Germany.
Surg Endosc. 2017 Aug;31(8):3140-3145. doi: 10.1007/s00464-016-5338-3. Epub 2016 Nov 14.
To identify parathyroid glands intraoperatively by exposing their autofluorescence using near-infrared light.
Fluorescence imaging was carried out during minimally invasive and open parathyroid and thyroid surgery. After identification, the parathyroid glands as well as the surrounding tissue were exposed to near-infrared (NIR) light with a wavelength of 690-770 nm using a modified Karl Storz near-infrared/indocyanine green (NIR/ICG) endoscopic system. Parathyroid tissue was expected to show near-infrared autofluorescence, captured in the blue channel of the camera. Whenever possible the visual identification of parathyroid tissue was confirmed histologically.
In preliminary investigations, using the original NIR/ICG endoscopic system we noticed considerable interference of light in the blue channel overlying the autofluorescence. Therefore, we modified the light source by interposing additional filters. In a second series, we investigated 35 parathyroid glands from 25 patients. Twenty-seven glands were identified correctly based on NIR autofluorescence. Regarding the extent of autofluorescence, there were no noticeable differences between parathyroid adenomas, hyperplasia and normal parathyroid glands. In contrast, thyroid tissue, lymph nodes and adipose tissue revealed no substantial autofluorescence.
Parathyroid tissue is characterized by showing autofluorescence in the near-infrared spectrum. This effect can be used to distinguish parathyroid glands from other cervical tissue entities.
通过使用近红外光暴露甲状旁腺的自体荧光，在术中识别甲状旁腺。
在微创和开放性甲状旁腺及甲状腺手术中进行荧光成像。识别后，使用改良的卡尔·史托斯近红外/吲哚菁绿（NIR/ICG）内镜系统，将甲状旁腺及其周围组织暴露于波长为690 - 770纳米的近红外（NIR）光下。甲状旁腺组织预计会显示近红外自体荧光，并在相机的蓝色通道中捕获。只要有可能，甲状旁腺组织的视觉识别会通过组织学进行确认。
在初步研究中，使用原始的NIR/ICG内镜系统时，我们注意到蓝色通道中光对自体荧光的严重干扰。因此，我们通过插入额外的滤光片对光源进行了改良。在第二个系列中，我们研究了来自25名患者的35个甲状旁腺。基于近红外自体荧光，正确识别了27个甲状旁腺。关于自体荧光的程度，甲状旁腺腺瘤、增生和正常甲状旁腺之间没有明显差异。相比之下，甲状腺组织、淋巴结和脂肪组织没有显示出明显的自体荧光。
甲状旁腺组织的特征是在近红外光谱中显示自体荧光。这种效应可用于将甲状旁腺与其他颈部组织实体区分开来。
