Abstract
BACKGROUND: Postoperative hypoparathyroidism is the most common complication of total thyroidectomy, often resulting from injury or devascularization of the parathyroid glands. OBJECTIVE: Indocyanine green fluorescence (ICG) technique has been applied in the last 10 years in different kinds of surgery including colorectal, oncological lymph node and endocrine surgery. Minimally invasive thyroidectomy, introduced more than 25 years ago, is a valid surgical option for selected benign and malignant thyroid disease with advantages in terms of cosmetic results and postoperative pain. Aim of this study is to evaluate the feasibility and safety of ICG during minimally invasive thyroidectomy to assess and predict parathyroid gland perfusion and guide preservation. METHODS: We report the initial experience in our center of ICG during minimally invasive video-assisted total thyroidectomy in a case series of 9 patients, using the Striker System® to assess parathyroid perfusion and guide preservation. Demographic and surgical data were registered with special attention to hypoparathyroidism. RESULTS: All patients underwent standard minimally invasive video-assisted total thyroidectomy; a standardized dose of ICG was administered intravenously. Real-time near-infrared imaging allowed for clear visualization of parathyroid vascularization, enabling the preservation of well-perfused glands and the auto transplantation of those removed into the sternothyroid muscle. Postoperative assessments, including serial measurements of serum calcium and parathyroid hormone levels, revealed a transient drop in two patients with overall correspondence to indocyanine green evaluation. CONCLUSION: These findings suggest that ICG angiographic imaging is a valuable adjunct in thyroid surgery, potentially reducing the risk of hypocalcemia by optimizing parathyroid preservation. Further studies are needed to standardize the technique and the evaluation score to confirm preliminary results on definitive hypoparathyroidism.