Department of Thyroid Surgery, Xiangya Hospital, Central South University, Changsha, China.
National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
Front Endocrinol (Lausanne). 2022 Jun 23;13:916557. doi: 10.3389/fendo.2022.916557. eCollection 2022.
Indocyanine green angiography (ICGA) has been used to identify and preserve the parathyroid glands (PGs), and to evaluate PGs viability and function during thyroid surgery. However, evidence on the utilization of IGCA in thyroid cancer and robotic surgery is lacking. The efficacy of IGCA remains to be evaluated in PTC patients undergoing bilateral axillo-breast approach robotic thyroidectomy (BABA RT) and central neck dissection (CND).
From March 2020 to August 2021, 81 papillary thyroid cancer (PTC) patients receiving total thyroidectomy and CND were enrolled in this retrospective analysis. An intravenous bolus of 7.5 mg ICG was administrated three times in the ICGA group (n=34). Medical records were reviewed and analyzed, including the baseline characteristics, surgical parameters, PGs-related parameters, and perioperative PTH and calcium levels.
The mean number of total identified PGs and preserved PGs were significantly more in the ICG group than in the control group (3.74 ± 0.45 vs. 3.15 ± 0.55, P<0.001; 3.12 ± 0.64 vs. 2.74 ± 0.57, P=0.007, respectively), as were PTH and calcium levels on POD 1 (23.16 ± 18.32 vs. 6.06 ± 7.74, P=0.039; 2.13 ± 0.11 vs. 2.08 ± 0.08, P=0.024, respectively). While there were no differences in PTH levels on POD 30. Additionally, patients with at least one well vascularized PG had higher ioPTH 3 and PTH on POD 1, which significantly suggested the absence of postoperative hypocalcemia. Although not statistically significant, ICGA seemed superior to relative ioPTH decline and ioPTH 3 in predicting postoperative hypocalcemia.
In PTC patients undergoing BABA RT and CND, ICGA is a simple, safe, effective, and cost-effective tool in better identification and preservation of PGs as well as evaluation of PGs viability and function, with the potential to preserve more PGs, guide more appropriate autotransplantation, and accurately predict postoperative hypocalcemia.
吲哚菁绿血管造影（ICGA）已被用于识别和保留甲状旁腺（PGs），并在甲状腺手术期间评估 PGs 的活力和功能。然而，ICGA 在甲状腺癌和机器人手术中的应用证据尚缺乏。在接受双侧腋窝-乳房入路机器人甲状腺切除术（BABA RT）和中央颈部清扫术（CND）的 PTC 患者中，ICGA 的疗效仍有待评估。
回顾性分析 2020 年 3 月至 2021 年 8 月期间接受全甲状腺切除术和 CND 的 81 例甲状腺乳头状癌（PTC）患者的病历。ICGA 组（n=34）静脉推注 7.5mgICG 三次。分析包括基线特征、手术参数、PGs 相关参数以及围手术期 PTH 和钙水平。
ICGA 组总识别 PGs 数和保留 PGs 数明显多于对照组（3.74±0.45 与 3.15±0.55，P<0.001；3.12±0.64 与 2.74±0.57，P=0.007），POD1 的 PTH 和钙水平也更高（23.16±18.32 与 6.06±7.74，P=0.039；2.13±0.11 与 2.08±0.08，P=0.024）。而 POD30 的 PTH 水平无差异。此外，至少有一个血供良好的 PG 的患者，POD1 的 ioPTH3 和 PTH 更高，这表明术后无低钙血症。虽然无统计学意义，但 ICGA 在预测术后低钙血症方面似乎优于相对 ioPTH 下降和 ioPTH3。
在接受 BABA RT 和 CND 的 PTC 患者中，ICGA 是一种简单、安全、有效、经济有效的工具，可更好地识别和保留 PGs，并评估 PGs 的活力和功能，有潜力保留更多的 PGs，指导更适当的自体移植，并准确预测术后低钙血症。
