Indocyanine Green and Autofluorescence Assistance in Parathyroid Identification During Thyroidectomy: Game‐Changer or Gimmick

ABSTRACT Objective To evaluate the effectiveness of near‐infrared autofluorescence (NIR AF) and indocyanine green (ICG) for parathyroid gland identification during thyroidectomy, pragmatically focusing on post‐operative hypocalcaemia. Methodology This retrospective study evaluated 95 patients undergoing total thyroidectomy in a single centre. Parathyroid glands were identified on visual inspection in all patients, and in the NIR AF/ICG group, further assisted by the NIR AF/ICG endoscopic system after intravenous ICG injection. Patients with parathyroid glands identification by both visual inspection and NIR AF/ICG imaging (ICG group) and those with visual inspection alone (non‐ICG group) were compared for post‐operative hypocalcaemia rate, serum calcium level change, calcium and vitamin D supplements use and dosage, operation time and length of stay. Subgroup analysis was performed for cases with central compartment lymph node dissection done for malignancy. Results There was no significant difference in the hypocalcaemia rate on post‐operative Day 1 between non‐ICG (64.3%) and ICG group (58.5%). The mean change in serum calcium level upon first follow up from pre‐operative baseline was slightly higher in ICG group (+0.086 mmol/L) than non‐ICG group (+0.016 mmol/L) with a statistically significant difference ( p = 0.008). There was no significant difference in calcium and vitamin D supplements use or dosage and operation time. The median length of stay was 3 days in ICG group and 4 days in non‐ICG group ( p = 0.025). Conclusions The use of NIR AF/ICG imaging in parathyroid gland identification in thyroidectomy appears feasible without prolonging operation time or length of stay. However, there appear to be no obvious benefits in post‐operative hypocalcaemia, except for a minimal improvement in early post‐operative serum calcium level, with calcium and vitamin D supplement use.