Preliminary experience with the EleVision IR system in detection of parathyroid glands autofluorescence and perfusion assessment with ICG.

Background: Postoperative hypoparathyroidism remains the most frequent complication of neck endocrine surgery. In order to reduce the incidence of this feared complication, several systems for imaging of near infrared autofluorescence (NIRAF) have been invented to help surgeons identify parathyroid glands (PTGs) and evaluate their vascularization. We evaluated the efficacy of the EleVision IR system in thyroid and parathyroid surgery. Methods: We used the EleVision IR system in 25 patients who underwent thyroid/parathyroid surgery or both at our institution between December 2020 and July 2021. At various stages of the surgery, the surgeon first looked for PTGs with the naked eye and then completed the visual inspection with NIRAF imaging. We then compared both the naked eye and NIRAF-supported PTGs detection rates. At the end of surgery, we performed indocyanine green angiography of PTGs in 17 patients. Results: In total, we identified 80% of PTGs: 65% with the naked eye only and additional 15% with the assistance of the EleVision IR system. 14 of 17 patients evaluated by ICG angiography had at least one well-vascularized PTG. Only one of these patients (a case of subtotal parathyroidectomy for tertiary hyperparathyroidism) developed symptomatic postoperative hypocalcemia despite a normal parathormone level. The three other patients had at least one remaining moderately-vascularized PTG and only one patient developed transient postoperative hypoparathyroidism. Conclusion: We concluded that EleVision IR provides an efficient support for identification and evaluation of PTGs, and may be of great assistance in endocrine surgery. The images are easy to interpret even for less experienced surgeons thanks to the different types of color visualization and the possibility to measure the relative fluorescence intensity of PTGs and surrounding tissues.

Ventilatory efficiency slope is associated with cardiopulmonary complications after thoracoscopic anatomical lung resection.

OBJECTIVES: The aim of this study was to identify whether steeper V.E/V. CO2 slope was associated with cardiopulmonary complications (CPC) after anatomical resection by video-assisted thoracic surgery. Long-term survival was analysed as secondary outcome. METHODS: We reviewed the files of all consecutive patients who underwent pulmonary anatomical resections by video-assisted thoracic surgery between January 2010 and October 2020 at the Centre for Thoracic Surgery of Western Switzerland. Logistic regression was used to investigate the risk of CPC associated with the V.E/V.CO2 slope and other possible confounders. Survival was analysed with Kaplan-Meier curves. Risk factors associated with survival were analysed with a Cox proportional hazards model. RESULTS: The V.E/V.CO2 slope data were available for 145 patients [F/M: 66/79; mean age (standard deviation): 65.8 (8.9)], which were included in the analysis. Patients underwent anatomical resection [lobectomy (71%) or segmentectomy (29%)] mainly for lung cancer (96%). CPC and all-cause 90-day mortality were 29% and 1%, respectively. The mean (standard deviation) percentage of the predicted V.O2peak was 70% (17). Maximum effort during cardiopulmonary exercise test was reached in only 31% of patients. The V.E/V.CO2 slope (standard deviation) was not different if the maximum effort was reached or not [39 (6) vs 37 (7), P = 0.21]. V.E/V.CO2 slope >35 was associated with an increased risk of CPC (odds ratio 2.9, 95% confidence interval 1.2, 7.2, P = 0.020). V.E/V.CO2 slope >35 was not associated with shorter survival censored for lung cancer-related death. CONCLUSIONS: V . E/V.CO2 slope >35 is significantly associated with postoperative CPC after anatomical resections by video-assisted thoracic surgery. CLINICAL REGISTRATION NUMBER CER-VD (SWITZERLAND): Project ID: 2021-00620.