The use of fluorescence in thyroidectomy significantly reduces the risk of affecting the parathyroid glands, which regulate calcium in the human body.
The HUB's Endocrine Surgery Unit is a benchmark in minimally invasive thyroid surgery.
Thyroidectomy, the total or partial removal of the thyroid gland, is the most common procedure in endocrine surgery. The most serious complication of this procedure is hypoparathyroidism. This causes hypocalcaemia, a temporary or permanent drop in blood calcium below normal levels due to damage to the parathyroid glands, located behind the thyroid.
The four parathyroid glands, about the size of a grain of rice, control calcium levels in the body. When a total thyroidectomy is performed, the glands must be preserved, but given their fragility, the operation often results in them being rendered useless. This causes hypocalcaemia, which can be transient or permanent, and can develop into a serious chronic disease requiring lifelong treatment.
In order to minimise this risk, the Endocrine Surgery Unit of the General and Digestive Surgery Department at the Bellvitge Hospital has published, for the first time in the world, a study with clinical data on indocyanine green (ICG) angiography-guided thyroidectomy. As Dr Pablo Moreno, head of the Endocrine Surgery Unit at the HUB, explains, "At the beginning of the surgery, we inject the ICG contrast to obtain a map that shows us where the blood vessels reach the parathyroid glands; we can then begin the intervention with greater certainty of not affecting them". In this way, the parathyroid glands are preserved objectively by visualising the vessels that nourish them and not intuitively, as was previously the case.
The unit's expertise has been fundamental in developing this technique, which was presented at the last World’s Congress of Surgery of the International Association of Endocrine Surgeons (IAES), held last August in Vienna. Since 2018, up to 120 patients have undergone fluorescence-guided surgery at the HUB and the results have been reported in several scientific articles. "In a first paper, published in JAMA Surgery, we showed that we can tell whether the parathyroid glands are functioning or not as soon as the surgery is over, and it was also determined that a single unaffected gland is enough to maintain the correct calcium levels," Dr Moreno says.
Now, the results of the latest article, published in the World Journal Surgery, confirm the benefits of indocyanine green (ICG) angiography-guided thyroidectomy to preserve the parathyroid glands. As Dr Moreno points out, "out of the last 56 patients we have treated with this procedure, only two have needed calcium for two or three days. None of them have had permanent hypoparathyroidism. Moreover, with just one preserved gland, we avoid a serious and lifelong complication along with the cost that this would entail for the patient's quality of life and for the health system".
In addition to Dr Moreno, in this study have also participated Dr Arantxa García Barrasa and Dr Mireia Pascua Solé -both from the Endocrine Surgery Unit at the HUB-, Dr José Luis Muñoz, from the Hospital de la Princesa (Madrid), and Dr Sebastià Videla and Dr Aurema Otero, from the Clinical Research Support Unit of the HUB and IDIBELL.
Some 4,000 thyroidectomies are performed annually in Catalonia. Some studies put the percentage of cases of permanent hypocalcaemia at between 1% and 3%. Other studies raise this percentage to 8%-9%. By its part, transitory hypocalcaemia, requiring only the administration of calcium for a certain time, is estimated at between 30% and 40% of all cases.
The HUB's Endocrine Surgery Unit is now working to ratify the results of the latest study with a randomised nationwide study, in which some twenty hospitals have already expressed their interest in participating.
Last June, the HUB organised the IDES 2022 (International Debates on Endocrine Surgery) course, dedicated monographically to the advantages of fluorescence to preserve the functioning of the parathyroid glands. The title of the course, "Towards zero hypoparathyroidism", sums up the great future goal of this paradigm shift in thyroid surgery.
Reference article:: Usefulness of ICG Angiography-Guided Thyroidectomy for Preserving Parathyroid Function; Pablo Moreno-Llorente, Arantxa García-Barrasa, Mireia Pascua-Solé