Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, United States.
Department of Endocrine Surgery, University Health Network, Toronto, ON, Canada.
Front Endocrinol (Lausanne). 2023 Aug 24;14:1233956. doi: 10.3389/fendo.2023.1233956. eCollection 2023.
Treatment options for thyroid pathologies have expanded to include scarless and remote access methods such as the transoral endoscopic thyroidectomy vestibular approach (TOETVA). Currently, no standardized methods exist for locating parathyroid glands (PGs) in patients undergoing TOETVA, which can lead to parathyroid injury and subsequent hypocalcemia. This early feasibility study describes and evaluates the hANDY-i endoscopic attachment for detecting PGs in transoral thyroidectomy.
We used a prototype parathyroid autofluorescence imager (hANDY-i) that was mounted to a 10-mm 0-degree endoscope. The device delivers a split screen view of Red-green-blue (RGB) and near-infrared autofluorescence (NIRAF) which allows for simultaneous anatomical localization and fluorescence visualization of PGs during endoscopic thyroid dissection.
One cadaveric case and two patient cases were included in this study. The endoscopic hANDY-i imaging system successfully visualized PGs during all procedures.
The ability to leverage parathyroid autofluorescence during TOETVA may lead to improved PG localization and preservation. Further human studies are needed to assess its effect on postoperative hypocalcemia and hypoparathyroidism.
甲状腺疾病的治疗选择已经扩展到包括无疤痕和远程访问方法，如经口内镜甲状腺切除术前庭入路（TOETVA）。目前，在接受 TOETVA 的患者中，尚不存在定位甲状旁腺（PGs）的标准化方法，这可能导致甲状旁腺损伤和随后的低钙血症。这项早期可行性研究描述并评估了 hANDY-i 内镜附件在经口甲状腺切除术检测 PGs 的应用。
我们使用了一种安装在 10 毫米 0 度内窥镜上的甲状旁腺自发荧光成像仪（hANDY-i）原型。该设备提供了红绿蓝（RGB）和近红外自发荧光（NIRAF）的分屏视图，允许在进行内镜甲状腺解剖时同时进行解剖定位和荧光可视化 PGs。
本研究纳入了 1 例尸体病例和 2 例患者病例。所有手术中，内镜 hANDY-i 成像系统均成功地可视化了 PGs。
在 TOETVA 期间利用甲状旁腺自发荧光的能力可能会改善 PG 定位和保护。需要进一步的人体研究来评估其对术后低钙血症和甲状旁腺功能减退的影响。
