Efficacy of indocyanine green fluorescence in predicting parathyroid vascularization during thyroid surgery.

BACKGROUND: We examined the value of indocyanine green (ICG) fluorescence angiography in predicting parathyroid vascularization following thyroid and central compartment surgeries. METHODS: Data were prospectively collected on adult patients undergoing thyroid and/or central compartment surgeries. Outcomes were compared in surgeries performed with and without ICG use. ICG scoring was used to quantify the vascularity of parathyroid glands. RESULTS: One hundred eleven patients were included; 43 (38.7%) patients underwent ICG injections. There was no significant difference in mean parathyroid hormone (PTH) changes at the end of surgery (29.24 vs 23.48 pg/mL, P = .38), symptomatic hypocalcemia (7.9% vs 3.9%, P = .37), or length of stay (1.095 ± 0.22 vs 0.912 ± 0.07 days, P = .51) between surgeries performed with and without ICG. The average vascularization score among individuals undergoing ICG angiography was 2.89 out of a maximum of 8 points. CONCLUSION: Low-flow ICG patterns are not associated with postoperative PTH changes or transient hypocalcemia and may lead to unnecessary parathyroid autotransplantation.

Surgery for Graves' disease in the era of robotic-assisted surgery: a study of safety and feasibility in the Western population.

PURPOSE: Thyroid surgery for Graves' disease is known to be associated with higher risk of complications. We seek to compare outcomes between robotic-assisted and open cervical approach thyroid surgery in patients with Graves' disease in the Western population. METHODS: We performed a retrospective cohort study using prospectively collected databases for patients undergoing robotic-assisted or conventional cervical approach thyroid surgery for Graves' disease at two academic medical centers, one in North America (New Orleans, LA) and one in Europe (Paris, France). RESULTS: A total of 102 patients were included, of which 56 (55%) underwent robotic thyroidectomy and 46 (45%) underwent conventional open cervical thyroidectomy. Mean age was 40.2 ± 13.2 years and 94 (92%) were females. Mean BMI for the sample was 27.7 ± 10.2 kg/m2. There was a trend towards larger specimen volume in the robotic-assisted group, 84.9 ± 62.2 cm3 versus 65.2 ± 40.5 cm3 (p = 0.07). Mean length of stay for the French patients undergoing robotic-assisted surgery was 3.2 ± 0.5 days. For the American cohort, length of stay was significantly shorter for robotic-assisted thyroidectomy, at 0.8 ± 0.4 days versus 1.0 ± 0.2 days (p = 0.003). Operative time was longer in patients who underwent robotic thyroidectomy (174.4 ± 33.5 min) compared to patients who underwent traditional cervical approach (121.2 ± 41.1 min, p < 0.0001). There was no difference in complication rates for the overall sample of patients undergoing robotic-assisted or open cervical procedures. CONCLUSION: Robotic thyroid surgery is safe in a select group of patients with Graves' disease in the Western population. Additional studies are warranted to further investigate these findings.