Clinical Challenges in Endocrine Surgery: Autofluorescence in Endocrine Surgery

Nov 23, 2023

Guest

Samantha Ruff

Guest

Priya H. Dedhia

Guest

John Phay

In this discussion, John Phay, a clinical professor and co-discoverer of parathyroid near-infrared autofluorescence, dives into its origins and clinical impact. Priya Dedhia, an assistant professor specializing in endocrine surgery, shares insights on comparing autofluorescence with indocyanine green (ICG) for identifying parathyroids. Samantha Ruff, a surgical oncology fellow, reviews studies highlighting how autofluorescence reduces early hypocalcemia, making a case for its use in complex surgeries. Together, they explore the future of surgical adjuncts in endocrine procedures.

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ANECDOTE

Discovery Born From A Frustrating Case

A resident, Lisa White, initiated the parathyroid fluorescence project after a difficult case and research interest.
John Phay and Vanderbilt engineers tested a Raman-spectroscopy probe and discovered parathyroid tissue had strong infrared fluorescence.

INSIGHT

Parathyroids Emit Distinct NIR Signal

Parathyroid glands exhibit strong intrinsic near-infrared autofluorescence peaking around ~820 nm.
This natural signal is distinct from surrounding tissues like fat, muscle, and thyroid, enabling intraoperative identification.

ADVICE

Choose Camera Or Probe Based On Workflow

Use autofluorescence cameras selectively because some require dimmed OR lights and may force you to view a screen.
Consider a probe device when you need real-time, hands-on identification without turning off lights.

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Making a discovery that changes how we practice is one of the most exciting things about the fields of medicine and surgery. In this episode, join endocrine surgeons Drs. Barb Miller, John Phay, Priya Dedhia, and Surgical Oncology Fellow Dr. Samantha Ruff from The Ohio State University. Hear Dr. Phay tell the story of how parathyroid autofluorescence was discovered and the work that has gone on since that day. The group discusses several articles focusing on intraoperative adjuncts used to identify parathyroid tissue during thyroid and parathyroid surgery.

Hosts: Barbra S. Miller, MD (Moderator), Clinical Professor of Surgery, John Phay, MD, Clinical Professor of Surgery, Priya H. Dedhia, MD, PhD, Assistant Professor of Surgery, Samantha Ruff, MD, Surgical Oncology Fellow, Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.

Twitter handles:
Barbra Miller - @OSUEndosurgBSM
John Phay – @JohnPhayMD
Priya Dedhia – @priyaknows
Samantha Ruff - @SamRuff_MD

Learning objectives:
1) Understand the background of the discovery of parathyroid autofluorescence
2) Describe various intraoperative adjuncts utilized to identify parathyroid tissue
3) Compare and contrast the advantages and disadvantages of using autofluorescence versus indocyanine green for identification of parathyroid tissue
4) Recognize the impact of use of intraoperative imaging adjuncts on postoperative hypocalcemia (short and long-term)
5) Understand the general safety issues for the parathyroid imaging techniques discussed

References:
1. Benmiloud, F., G. Godiris-Petit, R. Gras, et al., Association of Autofluorescence-Based Detection of the Parathyroid Glands During Total Thyroidectomy With Postoperative Hypocalcemia Risk: Results of the PARAFLUO Multicenter Randomized Clinical Trial. JAMA Surg, 2020. 155(2): p. 106-12 DOI: 10.1001/jamasurg.2019.4613. https://pubmed.ncbi.nlm.nih.gov/31693081/

2. Kahramangil, B. and E. Berber, Comparison of indocyanine green fluorescence and parathyroid autofluorescence imaging in the identification of parathyroid glands during thyroidectomy. Gland Surg, 2017. 6(6): p. 644-8 DOI: 10.21037/gs.2017.09.04. https://pubmed.ncbi.nlm.nih.gov/29302480/

3. Paras, C., M. Keller, L. White, et al., Near-infrared autofluorescence for the detection of parathyroid glands. J Biomed Opt, 2011. 16(6): p. 067012 DOI: 10.1117/1.3583571. https://pubmed.ncbi.nlm.nih.gov/21721833/

4. Vidal Fortuny, J., V. Belfontali, S.M. Sadowski, et al., Parathyroid gland angiography with indocyanine green fluorescence to predict parathyroid function after thyroid surgery. Br J Surg, 2016. 103(5): p. 537-43 DOI: 10.1002/bjs.10101. https://pubmed.ncbi.nlm.nih.gov/26864909/

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If you liked this episode, check out other Behind the Knife endocrine episodes: https://behindtheknife.org/podcast-category/endocrine/