Parathyroid autotransplantation during thyroidectomy among the European Society of Endocrine Surgeons: we still do not agree

The benefits of parathyroid autotransplantation (PAT) to prevent hypoparathyroidism are controversial. Our aim was to assess current indications and techniques for PAT during thyroidectomy among European Society of Endocrine Surgeons (ESES) members, incorporating the indications derived from indocyanine green (ICG) use, and compare them to a previous survey. An online survey was sent to all ESES members. Answers from 146 members from 30 countries and 132 centers were analyzed and compared to a previous (2015) survey. The commonest indications were “complete-devascularization” (90%) or “recovered-from-specimen” (72%) whereas “difficult-anatomical-disposition” (24%), “color-changes” (17%), and “score 0-ICG” (11%) were less common. The majority of polled surgeons (85%) performed autotransplantation in less than 10% of total thyroidectomies. Timing for autotransplantation varied from “at-the-end-of-the-procedure” (56%), after completing the lobectomy (25%) to immediately (18%). Parathyroids were usually kept in saline (67%) although a moistened gauze or frozen surface were also used. “Chopping” was the preferred fragmentation method (66%), followed by “slicing” (19%) and “triturating” (12%). The majority of surgeons fragmented the parathyroids from 3 mm to non-identifiable sizes and placed the fragments in a single pocket (70%). The number of fragments per pocket varied widely and the most common site for placement was the sternocleidomastoid muscle (90%). Among surgeons who responded to the previous survey, indications and technique did not show major differences, but 15% of them added ICG as a new criterion. The indications and surgical technique for PAT among ESES members were exceedingly diverse. Technical disparity may play a role in controversial results. Standardization initiatives are warranted.