Innovation in endocrine surgery: Auto fluorescence of parathyroid’s glands.

Postoperative hypoparathyroidism occurs in 15-30% after total thyroidectomy, remaining definitive in up to 4% and in patients requiring aggressive surgery (N+ or EET+ cancer) in up to 30%. Recently introduced, auto-fluorescence (AF) allows to easily recognize the parathyroids and combined with indocyanine green angiography (ICG) to reduce the rate of postoperative hypoparathyroidism. We evaluated its impact in patients undergoing total thyroidectomy plus central cervical dissection. One hundred and seventeen patients operated between January 2019 and February 2023 were included and divided into three groups: control (GC, 43 patients) in which the parathyroid glands were identified visually, identification by auto-fluorescence alone (AF, 41 patients) before dissection and IG group (33 patients, use of AF plus injection of 2ml of indocyanine green before dissection). Primary endpoint measured: rate of transient and permanent postoperative hypoparathyroidism. Secondary endpoint: length of surgery. Temporary hypoparathyroidism rate was 21/43 (48.8%) in CG, 16/41 (39%) in NR and 2/33 (6.1%) in ICG (p < 0.01). Definitive hypoparathyroidism rate was 4/43 (9.3%) in CG, 1/41 (2.4%) in NR and 0/31 (0%) in ICG (p = ns). Parathyroids identified: 146/172 in CG, 149/164 in NG and 125/132 in IG (p<0.01). Accidental resection: 28/172(CG), 15/164(NG) and 7/132(IG)(p<0.05). Transplanted parathyroids: 2/28(CG), 2/15(NG) and 4/7(IG)(p<0.05). Difference in length of surgery was not significant. The use of AF associated with ICG reduced the risk of temporary and definitive postoperative hypoparathyroidism by 5 and 9 times, respectively, in patients operated on for locally advanced thyroid carcinoma.