Utility of Indocyanine Green Fluorescence Imaging for Intraoperative Localization in Reoperative Parathyroid Surgery.
Background. Due to the variations in anatomic location, the identification of parathyroid glands may be challenging. Although there have been advances in preoperative imaging modalities, there is still a need for an accurate intraoperative guidance. Indocyanine green (ICG) is a new agent that has been used for intraoperative fluorescence imaging in a number of general surgical procedures. Its utility for parathyroid localization in humans has not been reported in the literature.Results. We report 3 patients who underwent reoperative neck surgery for primary hyperparathyroidism. Using a video-assisted technique with intraoperative ICG fluorescence imaging, the parathyroid glands were recognized and removed successfully in all cases. Surrounding soft tissue structures remained nonfluorescent, and could be distinguished from the parathyroid glands.Conclusions. This report suggests a potential utility of ICG imaging in intraoperative localization of parathyroid glands in reoperative neck surgery. Future work is necessary to assess its benefit for first-time parathyroid surgery.
Cleveland Clinic, Cleveland, OH, USA.
Sara
S
Sound
Cleveland Clinic, Cleveland, OH, USA.
Alexis
A
Okoh
Cleveland Clinic, Cleveland, OH, USA.
Hakan
H
Yigitbas
Cleveland Clinic, Cleveland, OH, USA.
Pinar
P
Yazici
Cleveland Clinic, Cleveland, OH, USA.
Eren
E
Berber
D000368:Aged; D005260:Female; D005456:Fluorescent Dyes / Q000627:therapeutic use*; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000000981:diagnostic imaging / Q000601:surgery; D007208:Indocyanine Green / Q000627:therapeutic use*; D008297:Male; D061848:Optical Imaging / Q000379:methods*; D010280:Parathyroid Glands / Q000000981:diagnostic imaging / Q000601:surgery; D012086:Reoperation / Q000379:methods; D025321:Surgery, Computer-Assisted / Q000379:methods*
D005456:Fluorescent Dyes; D007208:Indocyanine Green
ICG; fluorescence imaging; hyperparathyroidism; indocyanine green; parathyroid glands