40 - Hauptsitzung
16. Mai 2019, 08:30 - 10:15, Bellavista 5, 6. OG
Parathyroid indocyanine green angiography may help to reduce hypoparathyroidism after total thyroidectomy: a retrospective study in a consecutive series of 968 patients
M. S. Demarchi, W. Karenovics, J. Vidal Fortuny, F. Triponez, Presenter: M. S. Demarchi (Geneve)
Post-operative hypoparathyroidism is the most common complication after thyroidectomy occurring in up to 30% of patients; it’s the result of intentional or inadvertent extirpation, trauma, or devascularization of the parathyroid glands. Technical difficulty of the procedure, surgical expertise and parathyroid auto-transplantation, are associated with a reduction in the risk of surgical hypoparathyroidism. Intraoperative parathyroid imaging is among novel strategies being investigated to decrease the rate of surgical hypoparathyroidism Our study objective was to assess whether the introduction of parathyroid gland angiography with the fluorescent dye indocynine green (ICG) reduced the rate of hypoparathyroidism in a consecutive series of total thyroidectomies.
Retrospective observational study between January 2012 and October 2018 of all patients in our database (N=968) undergoing total thyroidectomy, comparing the incidence of hypoparathyroidism on post-operative day 1 (POD1) before and after the introduction of ICG angiography in 2014. Hypoparathyroidism was defined as PTH level <1.1 pmol/L. The serum levels of calcium and PTH on POD 1 were compared using student’s t-test.
POD1 hypoparathyroidism was observed statistically significantly less often in the 217 patients who had ICG angiography vs. 751 who did not (4% vs. 10%, p=0.0076). The overall rate of POD1 hypoparathyroidism decreased after May 2014, although not statistically significant (8.0%vs.10.4%, p=0.2075). Moreover, the PTH level on POD1 was statistically significantly higher in patients after the introduction of ICG angiography as compared to patients before (3.27pmol/l +/-1,70 vs. 2.77pmol/l +/-1,49, p=0.0000092 two-sided T-test). No differences in the mean serum POD1 calcium level was observed before (2,28mmol/l +/-0,19) and after (2,24mmol/l +/-0,18) the introduction of ICG angiography.
The use of ICG angiography was associated with a statistically significant decrease of hypoparathyroidism and higher POD1 PTH levels. This suggests that increased awareness of parathyroid vascularization could be a favorable adjunct to parathyroid preservation during total thyroidectomy.