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- Silver Karcioglu, Amanda L., et al.
(author)
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Emerging Imaging Technologies for Parathyroid Gland Identification and Vascular Assessment in Thyroid Surgery : A Review from the American Head and Neck Society Endocrine Surgery Section
- 2023
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In: JAMA Otolaryngology - Head and Neck Surgery. - : American Medical Association (AMA). - 2168-6181. ; 149:3, s. 253-260
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Research review (peer-reviewed)abstract
- Importance: Identification and preservation of parathyroid glands (PGs) remain challenging despite advances in surgical techniques. Considerable morbidity and even mortality result from hypoparathyroidism caused by devascularization or inadvertent removal of PGs. Emerging imaging technologies hold promise to improve identification and preservation of PGs during thyroid surgery. Observation: This narrative review (1) comprehensively reviews PG identification and vascular assessment using near-infrared autofluorescence (NIRAF) - both label free and in combination with indocyanine green - based on a comprehensive literature review and (2) offers a manual for possible implementation these emerging technologies in thyroid surgery. Conclusions and Relevance: Emerging technologies hold promise to improve PG identification and preservation during thyroidectomy. Future research should address variables affecting the degree of fluorescence in NIRAF, standardization of signal quantification, definitions and standardization of parameters of indocyanine green injection that correlate with postoperative PG function, the financial effect of these emerging technologies on near-term and longer-term costs, the adoption learning curve and effect on surgical training, and long-term outcomes of key quality metrics in adequately powered randomized clinical trials evaluating PG preservation.
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| 2. |
- Tolley, Neil S., et al.
(author)
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Rates of RLN and SLN injury : Data from national quality registries and the literature
- 2016
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In: The Recurrent and Superior Laryngeal Nerves. - Cham : Springer International Publishing. - 9783319277271 - 9783319277257 ; , s. 3-16
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Book chapter (peer-reviewed)abstract
- The impact of thyroid surgery on voice is a key performance indicator of surgical quality. This chapter discusses factors that can impact on the incidence of both recurrent and external laryngeal nerve (external branch of superior laryngeal nerve-EBSLN) injury. The literature is reviewed and reported incidence of nerve palsy following thyroid surgery is presented. Particular reference is made to the British and Scandinavian database registries. The present evidence supports that the true injury rate is underreported. Factors that might influence nerve injury are presented in an evidence-based manner. A centrally important dynamic in this area of study is that there is clear positive correlation between the rate of postoperative vocal cord examination and palsy. Overall, 10 % of patients can sustain a temporary laryngeal palsy following thyroidectomy. Permanent voice problems are common and the true incidence of permanent palsy remains unknown. There is little doubt, however, that the literature grossly underestimates its true incidence. Thirty percent of patients with a known vocal palsy may not complain of voice symptoms which again endorses the importance of routine post- operative vocal cord examination. Voice change secondary to EBSLN injury is also common and again the true incidence remains unknown. This situation prevails due to the difficulty of precise diagnosis with extant non- invasive methods of cord examination. The importance of surgical volume to patient outcomes is emphasized. Surgery for cancer particularly when involving nodal dissection has been identified as a significant and higher risk for nerve palsy as have been revision and more extensive thyroid surgery. Similarly, higher rates of nerve injury are reported with retrosternal goitres. The literature is unclear as to whether the side of thyroidectomy is a risk factor or whether certain benign pathology such as Graves' disease confers a higher risk of injury.
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