Near-infrared Autofluorescence Probe Versus Visual Identification for Parathyroid Detection and Functional Preservation During Total Thyroidectomy: A Randomized Controlled Trial.

OBJECTIVE

To assess whether PTeye-guided identification increases the number of parathyroid glands (PGs) preserved in situ and reduces hypoparathyroidism compared with visual identification alone.

BACKGROUND

Injury or inadvertent removal of PGs during thyroidectomy is the main cause of postoperative hypoparathyroidism. Reliance on visual inspection makes intraoperative PG identification difficult. Probe-based near-infrared autofluorescence (NIRAF) systems such as PTeye provide real-time, tissue-specific feedback that may enhance PG detection and preservation.

METHODS

In this single-center, prospective, randomized trial, patients undergoing first-time total thyroidectomy were allocated to PTeye-assisted or visual PG identification. Procedures were performed by 2 senior and 3 junior surgeons. The primary outcome was the number of PGs identified. Secondary outcomes included inadvertent parathyroidectomy, autotransplantation, and transient and last follow-up hypoparathyroidism.

RESULTS

Among 154 randomized patients (77 per group; mean age 53.4±14.3 y; 84.4% female), PTeye increased the mean number of PGs identified (3.81 vs. 2.73; P<0.001) and the proportion with 3-4 PGs preserved in situ (98.7% vs. 87.0%; P=0.004). Inadvertent parathyroidectomy was less frequent with PTeye (5.2% vs. 20.8%; P=0.004). Junior surgeons performed more autotransplantations than senior surgeons when using PTeye (33.3% vs. 10.5%; P=0.015). Female sex (P=0.047), ≤2 PGs preserved (P=0.008), and autotransplantation (P=0.010) predicted low postoperative day-1 parathormone serum level. Among junior surgeons, transient hypoparathyroidism was lower with PTeye (20.5% vs. 55.2%; P<0.001), with no difference among senior surgeons. Permanent hypoparathyroidism rates were similar between groups.

CONCLUSIONS

PTeye-guided NIRAF improves PG identification and in situ preservation and reduces transient hypoparathyroidism, particularly for junior surgeons, without affecting permanent hypoparathyroidism.