Inadvertent parathyroidectomy in thyroid surgery with and without near-infrared autofluorescence: a two-centre retrospective observational study.

PURPOSE: Inadvertent parathyroidectomy is a recognised complication of thyroid surgery and contributes to post-operative hypoparathyroidism. Adjuncts such as near-infrared autofluorescence imaging may aid parathyroid identification, but multi-centre evidence remains limited. This study evaluated rates of inadvertent parathyroidectomy in thyroid surgery performed with and without autofluorescence, and examined the impact of central neck dissection, participation in a fluorescence-guided surgery trial, and temporal changes in practice.

METHODS

This two-centre retrospective cohort study included adults undergoing hemithyroidectomy, total thyroidectomy, or completion thyroidectomy from 2021 to 2023. The primary outcome was inadvertent parathyroidectomy confirmed on histopathology. Key exposures were participation in a fluorescence-guided surgery trial and intraoperative near-infrared autofluorescence use. Prespecified subgroups were total/completion procedures and operations with or without central neck dissection.

RESULTS

A total of 829 operations were included. Inadvertent parathyroidectomy occurred in 18.5% overall. Rates were higher with central neck dissection than without (41.1% vs. 15.7%; p < 0.001). NIFTy trial participation showed no significant effect (17.4% vs. 18.7%; p = 0.816). Autofluorescence imaging was associated with lower rates overall (14.0% vs. 20.3%; p = 0.042), though the reduction was not statistically significant in the total/completion subgroup (15.1% vs. 23.6%; p = 0.053). Rates declined from 21.6% in 2021 to 13.9% in 2023 (p = 0.022).

CONCLUSIONS

Inadvertent parathyroidectomy remains common, particularly when central neck dissection is performed. Near-infrared autofluorescence may offer modest benefit, while temporal improvements likely reflect increased surgical and pathological awareness, routine specimen examination, and more consistent reporting practices.