Near-infrared Autofluorescence Probe Versus Visual Identification for Parathyroid Detection and Functional Preservation During Total Thyroidectomy: A Randomized Controlled Trial.
Marcin Barczyński, Agnieszka Pac, Karolina Krakowska et al.
✦ AI-curated · Sources linked
In 30 seconds
This single-center, prospective randomized trial compared PTeye-guided near-infrared autofluorescence with visual identification of parathyroid glands during first-time total thyroidectomy. Among 154 patients, PTeye increased the mean number of glands identified (3.81 vs. 2.73; P <0.001) and the proportion with 3-4 glands preserved in situ (98.7% vs. 87.0%; P =0.004). Inadvertent parathyroidectomy was also less frequent. Transient hypoparathyroidism was lower with PTeye among junior surgeons, but permanent hypoparathyroidism rates were similar between groups.
Key findings
- PTeye increased mean parathyroid glands identified to 3.81 vs. 2.73 (P <0.001).
- Preservation of 3-4 glands in situ was 98.7% vs. 87.0% (P =0.004).
- Inadvertent parathyroidectomy occurred in 5.2% vs. 20.8% (P =0.004) with PTeye versus visual identification.
- Among junior surgeons, transient hypoparathyroidism was 20.5% vs. 55.2% (P <0.001); permanent rates were similar between groups.
Why it matters
Parathyroid injury or removal is a major cause of hypoparathyroidism after thyroidectomy. In this trial, probe-guided identification improved gland detection and in situ preservation, with lower transient hypoparathyroidism among junior surgeons. The findings suggest that intraoperative tissue-specific feedback may be particularly useful where visual identification is more challenging, while the lack of a difference in permanent hypoparathyroidism limits conclusions about long-term benefit.
What to keep in mind
The trial was conducted at a single center and included procedures performed by only five surgeons. Permanent hypoparathyroidism rates were similar between groups.