Perioperative fluorescence visualization of parathyroid glands

Czech version

Authors: D. Míčková; M. Zavadil; H. Binková
Authors‘ workplace: Oddělení ORL, Vojenská nemocnice Brno
Published in: Otorinolaryngol Foniatr, 74, 2025, No. 2, pp. 145-152.
Category: Original Article
doi: https://doi.org/10.48095/ccorl2025145

Overview

Introduction: Hypoparathyroidism with hypocalcemia is one of the most common complications of thyroid surgery. Since 2022, at the Military Hospital Brno, we have been using intraoperative visualization of the parathyroid glands (PG) with Fluoptics, Fluobeam® LX (FF®) autofluorescence system. We would like to present the principle of this method and evaluate the benefits for surgeons and patients. Materials and methods: During thyroid surgery, we use the FF® system, which based on the fluorescent properties of PG, enables early intraoperative detection. Through a retrospective analysis, we assess the benefit of this method-especially the effect of using the FF® system during thyroid procedures on the reduction of the incidence of inadvertent resection of PG, the decrease in the incidence of postoperative hypocalcemia, and the effect of the use of FF® for the duration of the operation. Results: A total of 309 patients were evaluated. The group of patients operated without using FF® included 163 patients, and the group using FF® included 146 patients. PG was unintentionally removed in 16.6% of cases in the group without using FF®, and in 4.1% of cases in the group using FF®. A drop in the serum calcium level below 2.00 mmol/l was registered during the postoperative period in 18.4% in the group without using FF® and 13.7% in the group using FF®. Long-term calcium substitution was necessary in 5.5% cases in the group without using FF®, and 0.7% in the group using FF®. The average duration of total thyroidectomy using FF® increased by 10.9 minutes, and the duration of hemithyroidectomy increased by 2.4 minutes. Conclusion: According to our experience, intraoperative fluorescence imaging confirms a decrease in the incidence of inadvertent resection of PG. Reduction in the incidence of temporary and permanent hypocalcemia was not significant. The mean operative time was extended in units of minutes.

Keywords:

hypocalcemia – Fluorescence imaging – thyroidectomy – parathyroid glands

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