Canali Luca, Russell Marika D, Sistovaris Anthea, Abdelhamid Ahmed Amr H, Otremba Michael, Tierney Hien T, Triponez Frédéric, Benmiloud Fares, Spriano Giuseppe, Mercante Giuseppe, Randolph Gregory W
Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA.
Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.
Head Neck. 2025 Jan;47(1):225-234. doi: 10.1002/hed.27900. Epub 2024 Aug 5.
Hypocalcemia is the most common postoperative complication of total thyroidectomy. Near-infrared autofluorescence (NIRAF) technology is a surgical adjunct that has been increasingly utilized with the aim of preventing postoperative hypocalcemia, but its clinical benefits have not yet been firmly established. The aim of this study was to assess the clinical benefit of utilizing NIRAF technology in patients undergoing total thyroidectomy.
A systematic review and meta-analysis of randomized clinical trials was performed according to PRISMA guidelines.
Seven randomized clinical trials with 1437 patients (318 males, 22.13%) undergoing total thyroidectomy were included for analysis. Risk of postoperative hypocalcemia was reduced in the NIRAF arm (RR, 0.65; 95%CI, 0.50-0.84). Use of NIRAF was also associated with a reduction in the risk of permanent parathyroid dysfunction (RR, 0.46; 95%CI, 0.22-0.95) and inadvertent parathyroid gland resection (RR, 0.40; 95%CI, 0.26-0.60).
We present a systematic review and meta-analysis of randomized clinical trials examining the impact of NIRAF technology on preservation of parathyroid function. Our results suggest that use of camera-based NIRAF technology reduces the risk of postoperative hypocalcemia, permanent parathyroid dysfunction, and inadvertent parathyroid gland resection.
低钙血症是全甲状腺切除术后最常见的并发症。近红外自发荧光（NIRAF）技术是一种手术辅助手段，越来越多地被用于预防术后低钙血症，但其临床益处尚未得到确凿证实。本研究的目的是评估在接受全甲状腺切除术的患者中使用NIRAF技术的临床益处。
根据PRISMA指南对随机临床试验进行系统评价和荟萃分析。
纳入7项随机临床试验，共1437例接受全甲状腺切除术的患者（318例男性，占22.13%）进行分析。NIRAF组术后低钙血症风险降低（RR，0.65；95%CI，0.50 - 0.84）。使用NIRAF还与永久性甲状旁腺功能障碍风险降低（RR，0.46；95%CI，0.22 - 0.95）和意外甲状旁腺切除风险降低（RR，0.40；95%CI，0.26 - 0.60）相关。
我们对随机临床试验进行了系统评价和荟萃分析，以研究NIRAF技术对甲状旁腺功能保留的影响。我们的结果表明，使用基于摄像头的NIRAF技术可降低术后低钙血症、永久性甲状旁腺功能障碍和意外甲状旁腺切除的风险。
