Discussion
tumor, hypocalcemia, tumors, parathyroidism
PATHOLOGY, TUMOR, HYPOCALCEMIA, TUMORS
Because the size, shape, color, and position of the parathyroid gland are variable, they are difficult to identify during surgery. In most cases, their identification relies on the surgeon’s experience. Various techniques have been used in the clinic to ascertain the development and localization of a parathyroid gland, including preoperative ultrasonic localization (After Paras et al. (Randomized controlled trials explored the role of NIRAF in total thyroidectomy and demonstrated that it can effectively improve the detection rate and reduce the incidence of hypocalcemia (Strategies for In addition to structural protection, protection of parathyroid function was the main consideration, and doctors used techniques such as intraoperative indocyanine-green (ICG) to evaluate the blood supply to the parathyroid glands and guide autologous transplantation (In the NIRAF group, we found that more than 95% of the superior parathyroid glands and more than 85% of the inferior parathyroid glands were identified before the dangerous phase, which was much higher than that in the control group. No serious long-term parathyroidism was observed in the NIRAF group. The incidence of postoperative temporary parathyroidism and hypocalcemia in the NIRAF group was also lower than that in the control group, and postoperative PTH recovery in the NIRAF group was faster than that in the control group. In the control group, we found that, although the compact parathyroid glands were easy to identify, the blood supply might originate from the branches on the surface of the thyroid gland and these were susceptible to inadvertent disconnection when the capsule was dissected. In the NIRAF group, the parathyroid gland was located first, and its blood vessels could be dissected along the proximal direction, which could greatly improve the protection of the blood supply. For other non-compact parathyroid glands, although their blood supply was distant from the thyroid gland and easy to retain, it was difficult to locate and expose them with only the naked eye. They were sometimes found during specimen examination, or even during postoperative paraffin pathology. In the NIRAF group, we found that the location of most non-compact parathyroid glands could be identified before thyroidectomy or neck dissection was completed. Therefore, this method has obvious advantages in terms of protecting the structure and function of these glands.This study also has some limitations. The number of cases is small and it is a study from a single center and the same team. Secondly, the cases included in the study were all early tumors. For the cases with locally advanced tumors invading the capsule extensively, the parathyroid gland may be involved and difficult to image. In fact, it is more difficult to protect the parathyroid gland in the circumstances. Some of them can refer to our above procedures, while the tumor involved parts may require individualized treatment. Finally, we did not perform ICG imaging. Therefore, it is difficult to directly evaluate the blood supply of parathyroid glands, which can only be indirectly reflected by the postoperative PTH level. In the future, we will further expand the sample size and supplement relevant experiments.