The surgical landscape for thyroid disorders is evolving rapidly. Specifically, transoral endoscopic thyroidectomy via a vestibular approach (TOETVA) has gained popularity among specialists. However, surgeons often face significant challenges regarding the preservation of parathyroid glands. A recent pilot study investigated the impact of using ICG in transoral thyroidectomy to mitigate these risks effectively.

Researchers conducted a comparative longitudinal study involving 55 patients. They evaluated the effectiveness of intraoperative indocyanine green (ICG) for identifying parathyroid tissue. Specifically, the study compared calcium and parathyroid hormone (PTH) levels immediately and 24 hours post-surgery. These biomarkers are critical for assessing gland function following resection.

The results were quite promising for modern endocrine surgery. In the control group, the prevalence of biochemical postoperative hypoparathyroidism was 22%. In contrast, the group utilizing ICG saw this rate drop to just 7.2%. This statistically significant difference underscores the utility of ICG fluorescence in protecting patient outcomes.

Benefits of ICG in Transoral Thyroidectomy

The intraoperative use of ICG provides real-time visual confirmation of parathyroid vascularity. Consequently, surgeons can make more informed decisions about tissue preservation or autotransplantation. Furthermore, this technique does not significantly increase surgery time. In this study, the average operative time was approximately 99 minutes, which is comparable to standard procedures.

Additionally, blood loss remained minimal across the cohort, averaging less than 10 mL. Because hypoparathyroidism remains a major complication of thyroid surgery, these findings are highly relevant. Therefore, implementing ICG protocols could improve recovery and reduce the need for long-term calcium supplementation.

Frequently Asked Questions

How does ICG identify parathyroid glands?

Indocyanine green is a fluorescent dye that accumulates in well-vascularized parathyroid tissue. When viewed under near-infrared light, the glands glow, allowing surgeons to distinguish them from surrounding thyroid or fat tissues.

Does using ICG in transoral thyroidectomy reduce surgery time?

The study showed an average surgery time of 99 minutes. While the imaging adds a few minutes for injection and visualization, the clarity it provides helps in quicker identification of critical structures, potentially avoiding surgical delays caused by anatomical uncertainty.

What is biochemical hypoparathyroidism in this context?

In this study, biochemical hypoparathyroidism was defined as a parathyroid hormone (PTH) level below 15 pg/mL. The use of ICG significantly reduced the incidence of this condition compared to traditional visual identification alone.

Disclaimer: This content is for informational and educational purposes only. It does not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Refer to the latest local and national guidelines for clinical practice.

References

1. Domínguez-Rangel JA et al. [Prevention of hypoparathyroidism with indocyanine green in transoral thyroidectomy: Pilot study]. Rev Med Inst Mex Seguro Soc. 2026 May 06. doi: 10.5281/zenodo.18715336. PMID: 42090720.

2. Liang Y, et al. Indocyanine Green Angiography for Parathyroid Gland Evaluation during Transoral Endoscopic Thyroidectomy. MDPI. 2021;10(17):3814. doi: 10.3390/jcm10173814.

3. Vidal Fortuny J, et al. Randomized clinical trial of intraoperative parathyroid gland angiography with indocyanine green fluorescence predicting parathyroid function after thyroid surgery. Br J Surg. 2018;105(4):350-357.