A prospective cohort study of intraoperative parathyroid gland management by early and advanced career surgeons based on viability assessment by visual perception and indocyanine green (ICG) fluorescence imaging.
prospective_cohort · Level II
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- Record sourced from PubMed, PMID 41339204.
- Also identified by DOI 10.1016/j.surg.2025.109920.
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Abstract
Parathyroid gland identification and preservation during thyroidectomy has historically relied on experienced visual acumen. Indocyanine green fluorescence imaging has demonstrated improvement in parathyroid gland preservation, but it is unclear if the benefit is limited to less-experienced surgeons. The aim of this study was to identify how often discordant parathyroid viability assessments by surgeon visual perception versus indocyanine green fluorescence resulted in changes in management, stratified by surgeon years of experience. Patients undergoing thyroid surgery by high-volume endocrine surgeons were recruited. Perception of parathyroid viability was documented before and after intravenous indocyanine green administration. In cases of discordant assessments, management was at the surgeon's discretion. Rates of discordance and change in management were stratified by surgeon experience-"early career" (<5 years independent practice) and "advanced career" (>15 years independent practice). Results were analyzed using the Pearson χ<sup>2</sup> test. The primary outcome was the rate of change in management of the parathyroid on the basis of discordant assessments stratified by surgeon years of experience. Thirty-five patients were included and comprised 81 observations of parathyroid viability, 50 by early career surgeons and 31 by advanced-career surgeons. Early career surgeons had a discordance rate of 26.0% (n = 13/50) versus 19.3% (n = 6/31) for advanced career surgeons (χ<sup>2</sup> = 0.17329, P = .6722). Of the 19 discordant observations, 13 (68.4%) resulted in changes in management (early career = 10/13 = 76.9%; advanced career = 3/6 = 50.0%; χ<sup>2</sup> = 1.3772, P = .3093). These results suggest that indocyanine green fluorescence imaging is a useful adjunct to visual perception, regardless of the surgeon's years of experience.
Medical subject headings
- Indocyanine Green
- Parathyroid Glands
- Thyroidectomy
- Visual Perception
- Optical Imaging
- Clinical Competence
- Surgeons