During thyroidectomy, one of the main goals is to protect and maintain the function of the parathyroid glands. Otherwise, there is a risk of hypoparathyroidism leading to hypocalcemia (low calcium levels in the blood).

While permanent hypoparathyroidism is rare, transient hypocalcemia occurs more frequently and is accompanied by symptoms such as tingling, numbness in the hands and feet, muscle twitching, and cramps. To minimize these complications, modern technology offers a valuable new tool: the parathyroid autofluorescence camera, which is a non-invasive method of locating the parathyroid glands during surgery.

What is an autofluorescence camera?

The autofluorescence camera is based on a remarkable scientific discovery: the parathyroid glands emit a special light at a specific frequency in the near-infrared spectrum – known as autofluorescence. Thanks to this property, cameras have been developed that detect this light, helping to accurately visually locate the parathyroid glands during surgery.

This allows the surgeon to:

• To better protect the parathyroid glands

• Significantly reduce the risk of transient hypoparathyroidism

• To improve the possibilities of reimplanting a parathyroid gland in a removed peritoneum

What is parathyroid gland reimplantation?

In cases where the blood supply to a parathyroid gland is disrupted during surgery (e.g., a parathyroid embedded in the thyroid capsule), scientific studies have shown that reimplantation of the parathyroid gland into the sternocleidomastoid muscle almost eliminates the possibility of permanent hypoparathyroidism.

Practical application by Mr. Psychogios

Dr. Psychogios was one of the first thyroid surgeons in Greece to incorporate the autofluorescence camera (Fluobeam, Fluoptics) into daily thyroid and parathyroid surgery. Its use is extremely useful not only in standard procedures but also in complex cases, such as when lymph node dissection is required or when the anatomical position of the parathyroids is unusual (e.g. within the thyroid capsule), cases where reimplantation of a parathyroid gland may be required.

This technology increases the percentage of parathyroid glands that are detected and consequently improves the safety of the operation. It should be noted that the latest technology autofluorescence cameras used by Mr. PsychogiosFluobeam LX, Fluoptics) no longer require the intravenous use of dye during surgery, eliminating the risk of allergic reactions!

Clinical research & results

In collaboration with colleagues from the ENT clinic, we have initiated research protocols within the framework of a doctoral thesis, aiming to evaluate the effectiveness of the autofluorescence camera in the prevention of hypoparathyroidism.

The results so far show:

• Significant increase in parathyroid detection during surgery

• Better training of new surgeons in parathyroid gland recognition

• Increase in parathyroid replantations from thyroid preparations

• Reduction in the transient fall in parathyroid hormone on the first postoperative day

Although we have not yet observed a significant difference in permanent hypoparathyroidism, this is because we already apply techniques that make it extremely rare.

Detailed presentation in the video at minute 20:12