Ординатура / Хирургия / @xirurgi_2025 / @xirurgi_2025 - 715 - файл

least 10cc of normal saline or lactated ringers solution. The para­thyroid glands uoresce within 30–90 s if they remain well­vascularized, and the time to reach peak intensity of their uorescence as well as the degree of peak uorescence intensity may provide qualitative information for the adequacy of their per­fusion. If a likely single adenoma is conrmed, the blood supply to that gland may be ligated and the specimen removed; the sur­geon may proceed with wound closure if they have sufcient con­dence in removal of the pathologic gland. If there is uncertainty, the gland may be sent for frozen section, an intraoperative PTH level may be sent (with a 50% drop in PTH at 10min after resec­tion conrming cure), and/or the contralateral side may be explored. In the case of diffuse hyperplasia, the perfusion status of the glands on ICG FA should be noted and attention turned to the contralateral side. Once the presumed parathyroid glands on that side have been identied, the procedure with visualization of the eld using the uorescence imaging system and injection of ICG should be repeated. A gland that exhibits adequate enhancement with ICG should be selected to reduce the risk of postoperative hypoparathyroidism. Successive clipping of the gland chosen for partial preservation should then be performed until an appropriate remnant has been created, with a nal assessment of perfusion with the uorescence imaging system. If this process results in damage to the gland such that it appears inadequate, the gland should be excised, and the procedure repeated with one of the remaining glands. Once an appropriate remnant is created, the blood supply to the remaining glands may be ligated and the spec­imens removed.

hemorrhage, potentially leading to blood transfusions or even death [61, 62]. NIR uorescence imaging offers a natural opportunity for safer and more efcient surgery, particularly for minimally invasive approaches.

ing the vascularization of that tissue [64, 71]. Other studies have shown that it is helpful during laparoscopic adrenalectomy at dis­tinguishing between tissues of interest and identifying critical vascular structures [67, 69]. Support for more widespread use will require large, multicenter studies with clear denitions of out­comes of interest (e.g., recurrence rates, sufcient remnant adre­nal tissue, operative duration, complication rates).

Large, well-designed randomized trials with long-term follow-up are needed to determine the utility in preventing permanent hypo­calcemia in thyroid surgery and subtotal parathyroidectomy. Ran­domized trials and larger cohort studies are needed comparing traditional techniques with ICG FA during adrenal surgery to dene its effect on critical outcomes such as complete resection, recurrence, and preservation of a sufcient functional remnant during partial adrenalectomy. Quality data regarding operative duration using uorescence guidance compared to traditional sur­gery in all elds will also help to dene its optimal use and cost­effectiveness. Additionally, investigation into tissue- targeted uorophores, such as for identication of peripheral nerves in head and neck surgery, is in its infancy but has the potential to radically alter the landscape of FGS [72]. As FGS becomes more accessible and integrated into imaging platforms, perhaps the bar­riers to adopting the technology will fall and uorescence imag­ing will become even more broadly adopted by endocrine surgeons around the world.