Vereschako R. I., Gorobeiko M. B.

FLUORESCENCE-GUIDED SURGERY FOR THE MANAGEMENT OF THYROID AND PARATHYROID NEOPLASMS: THE ROLE OF A MODERN METHOD IN PREVENTION OF DISABLING COMPLICATIONS

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Vereschako R. I., Gorobeiko M. B.

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LITERATURE REVIEWS

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Scientific article

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Surgical treatment of benign and malignant thyroid and parathyroid lesions was and remains the primary therapy, but carries risks of serious complications to be associated with risk of patients disabilities. Of these complications, there are bleeding, palsy of recurrent laryngeal nerve (RLN) as well as postoperative hypoparathyroidism. The RLN palsy and postoperative hypoparathyroidism are rare among high-volume endocrine surgeons, however its risk is still considered in complicated cases. It is worth to mention that even well‑differentiated thyroid cancers (which often have good outcomes with surgery), require extensive procedures (total thyroidectomy and neck dissection) that increase the chance of parathyroid trauma and RLN damage. Reoperative neck surgery is especially hazardous because scarring and altered anatomy make it harder to distinguish parathyroid glands from metastatic nodes. Traditional intraoperative aids are intraoperative neuromonitoring (IONM) and preoperative imaging (CT, ultrasound) for the better planning, are limited in reliably localizing parathyroid tissue and visualizing the RLN. Fluorescence‑guided surgery (FGS), exploiting intrinsic parathyroid autofluorescence in the near‑infrared spectrum and enhanced signal with indocyanine green (ICG) fluorophore. FGS is emerged as an intraoperative adjunct for the conventional thyroid and parathyroid surgeries. A review of English and Ukrainian research literature (PubMed, Scopus, Google Scholar) shows that FGS systems (e.g., Fluobeam, PTeye, EleVision) improve identification of parathyroid glands and reduce inadvertent excision and rates of transient and permanent hypoparathyroidism. When combined with IONM, FGS appears to further lower RLN injury risk, as ICG angiography helps map vascular anatomy near the nerve and aid localization. Drawbacks include equipment costs, lack of standardized protocols, variability in autofluorescence signal, and the need for multicenter trials to define long‑term outcomes. FGS is a promising adjunct in endocrine neck surgery with potential to lessen disabling complications, but standardized research is needed to optimize its clinical use.

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Publication of the article:

«Bulletin of problems biology and medicine», 2026 Issue 2, 181, 43-47 pages, index UDC 616.441

DOI:

10.29254/2077-4214-2026-2-181-43-47