National Cheng-Kung University, Medical College and Hospital

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Presentation transcript:

National Cheng-Kung University, Medical College and Hospital The Utility of Indocyanine Green Angiography for The Viability of Parathyroid Glands during Thyroidectomy ---Primitive Report Shih-Ming Huang M.D Department of Surgery National Cheng-Kung University, Medical College and Hospital

Background & Purpose Indocyanine green (ICG)---Mechanism 1) Liver function 2) Biliary tree image 3) Sentinel lymph nodes 4) Angiography---a) Colon anastomosis b) Tissue perfusion Parathyroid gland-- ICG angiography a)Vascularity --- Endocrine b)Viability----S/P Thyroidectomy

ICG binds to plasma protein Absorption 805nm, re-emission 835nm

Biliary tree GI Tract

Background & Purpose Indocyanine green (ICG)---Mechanism 1) Liver function 2) Biliary tree image 3) Sentinel lymph nodes 4) Angiography---a) Colon anastomosis b) Tissue perfusion Parathyroid gland-- ICG angiography a)Vascularity --- Endocrine b)Viability----S/P Thyroidectomy

METHODS (50 GLANDS) ICG --25mg / 10ml distilled water), 3.3 ml iv Near-infrared machine 1) perfusion angiography 2) tissue staining Repeated injection-- 8-10 min. parathyroid gland Vascularized staining Vs Eye . If 1) Poor perfusion ICG , 2) congestion or 3)discordance Partial cutting --- Bleeding & repeated ICG

2 minutes No(-) ,Question(-), Ok(+)

Parathyroid tumor

(++)43 (++)1 3(+ -) (--)2 (- -)3 (+-)1

CONCLUSIONS: Intraoperative ICG angiography of parathyroid during thyroidectomy: 1)Confirming the viability by naked eye observation, and 2) Further Mx -- questionable viable gland.

Thanks very much for Your Attention