부갑상선 국소화를 위한 자가형광 비디오 모니터링의 유용성
Usefulness of Autofluorescence Video-Monitoring to Enhanced Localization of Parathyroid Glands
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Background and Objectives Near-infrared (NIR) fluorescence photo imaging provides realtime parathyroid anatomy enhancement. Moreover, autofluorescence enables intraoperative virtualreality parathyroid exploration of the optical characteristics of the parathyroid gland. Thisstudy was performed to demonstrate the new technique of visualizing the parathyroid gland usingvideo-guided autofluorescence during thyroid and parathyroid surgery and to evaluate theoutcomes. This is the first study that introduces the video-monitoring technique for intraoperativeparathyroid mapping. Subjects and Method A total of 26 patients underwent 18 total thyroidectomies and 8hemithyroidectomies in 2016. Fifty-six parathyroid glands were enrolled in this study. Surgerywas performed by NIR video-monitoring via thyroid lateral side dissection to find the parathyroidtissues and extract the thyroid glands. With the operation room light turned on, the parathyroidglands were identified by the video-guided autofluorescence detection technique carried out in 3stages (P1, P2, and P3), which are imaging with surgeon’s eyes before parathyroids exposure (P1),after identification (P2), and in extracted specimen (P3). Results The parathryoid autofluorescence could be video-monitored in real time by our NIRcamera system with the indoor room light turned on. Of the total 56 parathyroids, 52 were detectedby fluorescence. Of these, the location of 43 glands were predicted by using the high signal in a before-exposure state and the glands were confirmed as containing parathyroid tissues [in P1, sensitivity=82.69%, positive predictive value (PPV)=100.00%]. Of the nine glands that did not show highsignals in P1, seven glands visually showed fluorescence signals (in P1 and P2, sensitivity=96.15%,PPV=100.00%). One of the two glands that showed high signals in the extracted tissue was identifiedas parathyroid, but the other one was proved not by histologic examination by despite high intensityfluorescence signal (in P1-P3, sensitivity=100.00%, PPV=98.08%). The accuracy of videoguidedparathyroid mapping in P1, P2, and P3 were 83.93%, 96.43%, and 96.43%, respectively. Conclusion This is the first study that demonstrates the parathyroid gland autofluorescence asa real-time video-monitoring technique and shows that it could be applied to real surgery. Althoughparathyroid autofluorescence is a phenomenon seen in the invisible wavelength, our datasuggest that the operator can see the parathyroid fluorescent signal in real time on the videomonitor. This technique could help the operator to predict the gland location and preserve themsafely.
Abstract
Background and Objectives Near-infrared (NIR) fluorescence photo imaging provides realtime parathyroid anatomy enhancement. Moreover, autofluorescence enables intraoperative virtualreality parathyroid exploration of the optical characteristics of the parathyroid gland. Thisstudy was performed to demonstrate the new technique of visualizing the parathyroid gland usingvideo-guided autofluorescence during thyroid and parathyroid surgery and to evaluate theoutcomes. This is the first study that introduces the video-monitoring technique for intraoperativeparathyroid mapping. Subjects and Method A total of 26 patients underwent 18 total thyroidectomies and 8hemithyroidectomies in 2016. Fifty-six parathyroid glands were enrolled in this study. Surgerywas performed by NIR video-monitoring via thyroid lateral side dissection to find the parathyroidtissues and extract the thyroid glands. With the operation room light turned on, the parathyroidglands were identified by the video-guided autofluorescence detection technique carried out in 3stages (P1, P2, and P3), which are imaging with surgeon’s eyes before parathyroids exposure (P1),after identification (P2), and in extracted specimen (P3). Results The parathryoid autofluorescence could be video-monitored in real time by our NIRcamera system with the indoor room light turned on. Of the total 56 parathyroids, 52 were detectedby fluorescence. Of these, the location of 43 glands were predicted by using the high signal in a before-exposure state and the glands were confirmed as containing parathyroid tissues [in P1, sensitivity=82.69%, positive predictive value (PPV)=100.00%]. Of the nine glands that did not show highsignals in P1, seven glands visually showed fluorescence signals (in P1 and P2, sensitivity=96.15%,PPV=100.00%). One of the two glands that showed high signals in the extracted tissue was identifiedas parathyroid, but the other one was proved not by histologic examination by despite high intensityfluorescence signal (in P1-P3, sensitivity=100.00%, PPV=98.08%). The accuracy of videoguidedparathyroid mapping in P1, P2, and P3 were 83.93%, 96.43%, and 96.43%, respectively. Conclusion This is the first study that demonstrates the parathyroid gland autofluorescence asa real-time video-monitoring technique and shows that it could be applied to real surgery. Althoughparathyroid autofluorescence is a phenomenon seen in the invisible wavelength, our datasuggest that the operator can see the parathyroid fluorescent signal in real time on the videomonitor. This technique could help the operator to predict the gland location and preserve themsafely.
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