TOETVA parathyroid autofluorescence detection: hANDY-i endoscopy attachment

BackgroundTreatment options for thyroid pathologies have expanded to include scarless and remote access methods such as the transoral endoscopic thyroidectomy vestibular approach (TOETVA). Currently, no standardized methods exist for locating parathyroid glands (PGs) in patients undergoing TOETVA, which can lead to parathyroid injury and subsequent hypocalcemia. This early feasibility study describes and evaluates the hANDY-i endoscopic attachment for detecting PGs in transoral thyroidectomy.MethodsWe used a prototype parathyroid autofluorescence imager (hANDY-i) that was mounted to a 10-mm 0-degree endoscope. The device delivers a split screen view of Red-green-blue (RGB) and near-infrared autofluorescence (NIRAF) which allows for simultaneous anatomical localization and fluorescence visualization of PGs during endoscopic thyroid dissection.ResultsOne cadaveric case and two patient cases were included in this study. The endoscopic hANDY-i imaging system successfully visualized PGs during all procedures.ConclusionThe ability to leverage parathyroid autofluorescence during TOETVA may lead to improved PG localization and preservation. Further human studies are needed to assess its effect on postoperative hypocalcemia and hypoparathyroidism.

Automated summary

This study explored the use of the hANDY-i endoscopic attachment for detecting parathyroid glands during transoral thyroidectomy. The device successfully visualized the parathyroid glands using a split screen view of RGB and NIRAF. This technique may improve the localization and preservation of parathyroid glands, but further studies are needed to assess its impact on postoperative hypocalcemia and hypoparathyroidism.