Will the autofluorescence take over inadvertent parathyroidectomy?Results from a multicentre cohort study

Recently, several devices exploiting the near-infrared autofluorescence (NIR-AF) of parathyroid glands (PGs) have been developed.Nevertheless, their impact on both preserving PGs from inadvertent surgical dissection and on post-surgical hypoparathyroidism(hypoPTH) is controversial. Methods A retrospective study of 845 patients undergoing thyroid surgery in 2 academic tertiary centres was conducted. In 291 patients, a NIR-AF device was used during surgery to identify PGs. The characteristics of the cohort were examined. The number of PGs identifiedduring surgery, missed PGs, auto-transplants, inadvertent parathyroidectomies, as well as the occurrence of transient and permanenthypoPTH, were analysed. Results The use of NIR-AF device resulted in a higher identification of PGs (92% versus 88%, p = 0.0008), and a significant reduction in thenumber of PGs inadvertently removed and detected on histopathological examination (4.7% versus 6.5%, p = 0.045). An increase in PGauto-transplantations was observed in the NIR-AF + group (10.4% versus 3.5%, p < 0.0001). The use of NIRAF did not significantlyimpact the occurrence of either transient or permanent hypoPTH. Conclusion Intraoperative NIR-AF detection is a promising technology to reduce incidental parathyroidectomies in thyroid surgery. AQ1 Theimpact of this technology on the occurrence of post-surgical hypoPTH needs to be furtherly investigated.