Intraoperative Autofluorescence Imaging for Parathyroid Gland Identification during Total Laryngectomy with Thyroidectomy

Hypoparathyroidism is a known complication of total laryngectomy, although parathyroid preservation and/or reimplantation is not routine. Autofluorescence is a new technique for identifying parathyroid glands intraoperatively. The aim of this study was to evaluate the feasibility of autofluorescence in this context. We retrospectively reviewed 18 patients. Twelve had concomitant total thyroidectomy and 6 thyroid lobectomy. A median of 2 parathyroid glands were identified per patient, with 92% of them being found using the autofluorescent camera before visualization by the surgeon. Due to the wide excision for cancer all of the parathyroids were reimplanted, none showing tumor cells on intraoperative frozen section analysis. Only one patient (8%) had permanent hypoparathyroidism after 6 months and no cancer recurrence was observed in the sites of parathyroid reimplantation. Autofluorescence was an aid in finding parathyroid glands in these wide tumor resections and reimplantation of the devascularized glands was safe. Objective: Hypoparathyroidism is a known complication of total laryngectomy, although parathyroid preservation and/or reimplantation are not routine. Autofluorescence is a new technique for identifying parathyroid glands intraoperatively. The aim of this study was to evaluate the feasibility of autofluorescence in this context. Materials and Methods: A retrospective study of patients undergoing total laryngectomy/pharyngectomy with concomitant thyroidectomy using the Fluobeam(R) (Fluoptics, Grenoble, France) and frozen section of a parathyroid fragment in case of reimplantation. The rates of identification using autofluorescence, reimplantation, and hypoparathyroidism were evaluated. Results: Eighteen patients (16 males, median age 67) underwent total laryngectomy/pharyngectomy with total thyroidectomy (n = 12) or hemithyroidectomy (n = 6). A median of 2 parathyroid glands were identified per patient. Ninety-two percent were identified by autofluorescence before visualisation. All parathyroids were reimplanted due to devascularization. Temporary hypoparathyroidism occurred in nine patients, and was permanent in one patient. After 34 months of median follow-up (range 1-49), no tumor recurrence was observed in the reimplantation sites. Conclusions: To our knowledge, this is the largest study to evaluate autofluorescence during total laryngectomy with thyroidectomy. No tumor recurrence occurred in the sites of parathyroid reimplantation.

Automated summary

Autofluorescence is a new technique that can help surgeons identify parathyroid glands during surgery, reducing the risk of hypoparathyroidism in patients undergoing total laryngectomy. This study found that autofluorescence successfully identified the parathyroid glands in the majority of patients, and reimplanting the glands after cancer resection was safe and did not result in tumor recurrence.