Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 6, 2020; 8(21): 5480-5486
Published online Nov 6, 2020. doi: 10.12998/wjcc.v8.i21.5480
Potential protection of indocyanine green on parathyroid gland function during near-infrared laparoscopic-assisted thyroidectomy: A case report and literature review
Shu-Jia Peng, Ping Yang, Yan-Ming Dong, Lin Yang, Zhen-Yu Yang, Xi-E Hu, Guo-Qiang Bao
Shu-Jia Peng, Ping Yang, Yan-Ming Dong, Lin Yang, Zhen-Yu Yang, Xi-E Hu, Guo-Qiang Bao, Department of General Surgery, Tangdu Hospital, Air Force Military Medical University, Xi’an 710032, Shannxi Province, China
Author contributions: Bao GQ contributed to the conception; Bao GQ, Yang P, and Peng SJ performed the operation; Bao GQ and Peng SJ handled the imaging; Yang P and Dong YM collected the data; Yang L, Yang ZY, and Hu XE drafted the manuscript; Bao GQ reviewed and revised the manuscript.
Informed consent statement: Informed content was obtained from the patient.
Conflict-of-interest statement: The authors declare no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Guo-Qiang Bao, MD, Assistant Professor, Associate Chief Physician, Doctor, Surgeon, Department of General Surgery, Tangdu Hospital, Air Force Military Medical University, No. 569 Xinsi Road, Xi’an 710032, Shannxi Province, China. guoqiang@fmmu.edu.cn
Received: June 28, 2020
Peer-review started: June 28, 2020
First decision: July 24, 2020
Revised: August 5, 2020
Accepted: August 29, 2020
Article in press: August 29, 2020
Published online: November 6, 2020
Abstract
BACKGROUND

In recent decades, significant advances have been made in protecting the parathyroid glands and recurrent laryngeal nerves during thyro-idectomy. However, reliable and convenient technical means are still lacking. In this study, the reliability, safety and feasibility of near-infrared (NIR) laparoscopy-assisted thyroid lobectomy with isthmectomy and prophylactic central lymph node dissection (CLND) were reported.

CASE SUMMARY

A 63-year-old female patient with a free previous medical history, was admitted to our department due to multiple thyroid nodules. Ultrasonic examination suggested diffuse thyroid changes and one thyroid nodule in the right upper lobe with the largest diameter of 1.5 cm adjacent to the trachea and Breast Imaging Reporting and Data System grade 4B. Imaging examination of the neck showed no obvious enlarged lymph nodes. Fine needle aspiration biopsy suggested a papillary thyroid carcinoma. Combined with thyroid function examination, the patient was diagnosed with papillary thyroid carcinoma and Hashimoto's thyroiditis. Considering the risk of invading the capsule and the patient's extreme anxiety, a right thyroid lobectomy with isthmectomy and prophylactic CLND was planned. No significant abnormalities were found during preoperative examinations, except for an increased thyroid stimulating hormone level. The patient underwent NIR laparoscopy-assisted thyroid lobectomy with isthmectomy and prophylactic CLND. During the operation, two right parathyroid glands (PGs) adjacent to the thyroid gland capsule and the right recurrent laryngeal nerve (RLN) were examined by indocyanine green (ICG) fluorescence using a NIR fluorescence camera, and the PGs and RLN were reliably preserved. Considering the ICG-positive PG, prophylactic CLND was performed. The postoperative parathyroid hormone level was in the normal range and no significant hypocalcemia symptoms were observed.

CONCLUSION

During NIR laparoscopy-assisted thyroidectomy, ICG fluorescence may aid PG identification and protection.

Keywords: Indocyanine green, Near-infrared laparoscopy, Carbon nanoparticles, Hypoparathyroidism, Thyroidectomy, Case report

Core tip: A female patient was admitted to our department due to thyroid nodules. Fine needle aspiration biopsy suggested a papillary thyroid carcinoma. The patient underwent near-infrared (NIR) laparoscopy-assisted thyroid lobectomy with isthmectomy and prophylactic central lymph node dissection. During the operation, two right parathyroid glands (PGs) adjacent to the thyroid gland capsule and the right recurrent laryngeal nerve were examined by indocyanine green fluorescence using a NIR fluorescence camera, and the PGs and recurrent laryngeal nerve were reliably preserved. The postoperative parathyroid hormone level was in the normal range and no significant hypocalcemia symptoms were observed. During NIR laparoscopy-assisted thyroidectomy, indocyanine green fluorescence may aid PG identification and protection.