Intraoperative localization of the parathyroid glands with indocyanine green and Firefly(R) technology during BABA robotic thyroidectomy
Intraoperative localization of the parathyroid glands with indocyanine green and Firefly(R) technology during BABA robotic thyroidectomy
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DOI：
10.1007/s00464-016-5330-y
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发表时间：
2017-07-01
影响因子：
3.1
通讯作者：
Lee, Kyu Eun
中科院分区：
文献类型：
--
作者：
Yu, Hyeong Won;Chung, Joon Woo;Lee, Kyu Eun
背景目前尚不清楚近红外（NIR）光诱导的吲哚菁绿色（ICG）荧光是否可以有效地识别，从而允许在双侧腋胸入路（BABA）机器人甲状腺切除术中保留甲状旁腺。本病例对照研究采用前瞻性招募的连续系列和回顾性选择的对照组，评估了采用Firefly（R）技术的ICG在BABA机器人甲状腺切除术中识别甲状旁腺的有用性。方法所有连续患者（N = 22）计划于2013年12月接受BABA机器人甲状腺切除术治疗甲状腺乳头状癌，2015年8月，前瞻性招募符合研究合格性标准的受试者。ICG荧光与集成在da芬奇Si机器人系统中的Firefly系统（NIR照明器：805 nm;滤光器：825 nm）一起使用，以识别下甲状旁腺。在术后第0、1、2和14天记录甲状旁腺激素水平。使用倾向评分匹配来识别年龄、性别、肿瘤大小和手术类型匹配的对照组患者，这些患者在没有Firefly系统的情况下接受BABA机器人甲状腺切除术。结果ICG荧光介导的甲状旁腺和甲状腺的识别平均（范围）分别需要203 +/- 89（125-331）和207 +/- 112（130-356）s。这些腺体中的平均（范围）荧光持续时间分别为20.8 +/- 6.0（16.6-35.8）和20.1 +/- 7.3（15.5-33.8）min。ICG组的甲状旁腺意外切除率显著低于对照组（0 vs.15.9%，P = 0.048）。结论ICG结合近红外光可安全、有效地识别BABA机器人甲状腺切除术中的甲状旁腺。
Background It is unclear whether near-infrared (NIR) light-induced indocyanine green (ICG) fluorescence can effectively identify, and thus permit the preservation of, parathyroid glands in bilateral axillo-breast approach (BABA) robotic thyroidectomy. This case-control study with a prospectively recruited consecutive series and a retrospectively selected control group assessed the usefulness of ICG with Firefly(R) technology to identify the parathyroid glands intraoperatively during BABA robotic thyroidectomy.Methods All consecutive patients (N = 22) who were scheduled to undergo BABA robotic thyroidectomy for papillary thyroid carcinoma in December 2013-August 2015 and met the study eligibility criteria were recruited prospectively. ICG fluorescence was used with the Firefly system (NIR illuminator: 805 nm; filter: 825 nm) integrated in the da Vinci Si robot system to identify the lower parathyroid glands. Parathyroid hormone levels were recorded on postoperative days 0, 1, 2, and 14. Propensity score matching was used to identify an age-, gender-, tumor size-, and operation type-matched group of control patients who underwent BABA robotic thyroidectomy without the Firefly system. The two groups were compared in terms of parathyroid-related outcomes.Results ICG fluorescence-mediated identification of the parathyroid and thyroid glands required on average (range) 203 +/- 89 (125-331) and 207 +/- 112 (130-356) s, respectively. The mean (range) fluorescence duration in these glands was 20.8 +/- 6.0 (16.6-35.8) and 20.1 +/- 7.3 (15.5-33.8) min, respectively. The ICG group had a significantly lower rate of incidental parathyroidectomy than the control group (0 vs. 15.9%, P = 0.048).Conclusions ICG with NIR light may feasibly and safely identify the parathyroid glands in BABA robotic thyroidectomy.