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Accurate identification of parathyroid glands, usually based on visual inspection and palpation, is crucial to successful thyroid and parathyroid surgery. It can be challenging even for experienced surgeons due to variability on the number and location of the parathyroid glands. Fluorescence imaging techniques are on the rise, as a useful adjunct for the detection of parathyroid glands.
Intravenous administration of indocyanine green enables the real‐time direct imaging and assessment of tissue perfusion and vascularization, which is key in the functional intraoperative evaluation of the parathyroid glands. Moreover, although indocyanine green is not specifically bound to the parathyroid parenchyma, it has been suggested that it tends to accumulate in the parathyroid adenomas due to the increased blood flow, allowing intraoperative real time location and determination of perfusion integrity.
Moreover, despite the application of fluorescent dyes, parathyroid glands also exhibit a unique autofluorescence signature. The detection of autofluorescence is a dye-free technique that allows noninvasive, real-time identification and precise localization of parathyroid glands, helping its differentiation from adipose tissue and ganglia. It is very useful on ectopic glands.
In thyroid surgery fluorescence imaging techniques allow the preservation of the parathyroid glands and the prevention of postoperative hypoparathyroidism, while in parathyroid surgery helps to ensure a successful resection of the adenoma. Fluorescence imaging techniques are safe, require no radiation, and can be easily integrated into the surgical workflow.