Bakkar Sohail, Chorti Angeliki, Papavramidis Theodosis, Donatini Gianluca, Miccoli Paolo
Department of General and Specialized Surgery, Faculty of Medicine, The Hashemite University, Zarqa, 13133, Jordan.
Department of General and Specialized Surgery, Faculty of Medicine, the Hashemite University, Zarqa, 13131, Jordan.
Surg Endosc. 2025 May;39(5):2964-2972. doi: 10.1007/s00464-025-11675-8. Epub 2025 Mar 21.
The role of near-infrared autofluorescence (NIRAF)-imaging in thyroid surgery is well-established. However, its role in hyperparathyroidism surgery is yet to be defined due to the lack of consensus regarding the autofluorescence (AF) pattern of parathyroid adenomas (PAs). Furthermore, its utility in minimally invasive video-assisted parathyroidectomy (MIVAP) has yet to be assessed.
To assess the feasibility of utilizing NIRAF-imaging via the limited-access of MIVAP and whether PAs demonstrate a unique AF signature allowing NIRAF-imaging to serve as an intraoperative diagnostic tool.
The clinical records of patients who underwent MIVAP for hyperparathyroidism between February and October 2024 were retrospectively reviewed. The primary endpoint was to assess the feasibility of NIRAF-imaging in MIVAP and whether PAs demonstrate a defining AF pattern. Secondary endpoints included whether certain AF patterns of PAs correlated with specific PA features including cell type, size, and/or location. Furthermore, operative-time and cost implications were assessed.
24 consecutive patients underwent MIVAP for hyperparathyroidism. NIRAF-imaging was feasible via the limited-access with no technical difficulties reported. AF patterns included high-intensity AF in 10 (38.5%), low-intensity AF in 10 (38.5%), and cap AF in 6 (23%). A new AF pattern was also described and referred to as "double cap AF". No significant differences in the patterns of AF were observed (p = 0.2). The pattern of AF did not considerably correlate with the predominant cell type, size or location of the PA. However, mediastinal PAs demonstrated a significantly higher tendency for cap AF. The additional time added to the procedure applying the technology was only a few minutes. However, it conferred a considerable additional cost.
In experienced hands, a direct minimal-access did not preclude utilizing NIRAF-imaging. PAs seem to lack a uniform characteristic AF signature implying a limited diagnostic role of NIRAF-imaging in parathyroid surgery apart from confirming normal parathyroid tissue. The study has been registered in ClinicalTrials.gov; registration number: NCT06779760.
近红外自发荧光（NIRAF）成像在甲状腺手术中的作用已得到充分确立。然而，由于甲状旁腺腺瘤（PA）的自发荧光（AF）模式缺乏共识，其在甲状旁腺功能亢进手术中的作用尚未明确。此外，其在微创视频辅助甲状旁腺切除术（MIVAP）中的效用尚未得到评估。
评估通过MIVAP的有限入路利用NIRAF成像的可行性，以及PA是否表现出独特的AF特征，使NIRAF成像能够作为术中诊断工具。
回顾性分析2024年2月至10月期间接受MIVAP治疗甲状旁腺功能亢进患者的临床记录。主要终点是评估NIRAF成像在MIVAP中的可行性，以及PA是否表现出明确的AF模式。次要终点包括PA的某些AF模式是否与特定的PA特征相关，包括细胞类型、大小和/或位置。此外，还评估了手术时间和成本影响。
24例连续患者接受了MIVAP治疗甲状旁腺功能亢进。通过有限入路进行NIRAF成像可行，未报告技术困难。AF模式包括高强度AF 10例（38.5%）、低强度AF 10例（38.5%）和帽状AF 6例（23%）。还描述了一种新的AF模式，称为“双帽状AF”。未观察到AF模式的显著差异（p = 0.2）。AF模式与PA的主要细胞类型、大小或位置没有显著相关性。然而，纵隔PA表现出帽状AF的显著更高倾向。应用该技术增加到手术中的额外时间仅为几分钟。然而，它带来了相当大的额外成本。
在经验丰富的医生手中，直接的小切口入路并不妨碍使用NIRAF成像。PA似乎缺乏统一的特征性AF特征，这意味着NIRAF成像在甲状旁腺手术中的诊断作用有限，除了确认正常甲状旁腺组织外。该研究已在ClinicalTrials.gov注册；注册号：NCT06779760。
