ArticleUpdates in surgery2026
Association of combined near-infrared autofluorescence and indocyanine green angiography with immediate and permanent postoperative hypoparathyroidism after thyroid surgery: a propensity score-matched analysis.
Article in Updates in surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Hypoparathyroidism remains the most frequent complication after thyroid surgery and is mainly related to inadvertent parathyroid excision or gland devascularization. Near-infrared autofluorescence (NIRAF) enables real-time identification of parathyroid glands, whereas indocyanine green angiography (ICGa) allows intraoperative assessment of gland perfusion. Their combination may improve parathyroid outcomes. We conducted a retrospective cohort study with propensity score matching including adult patients undergoing primary bilateral thyroid resection between October 2023 and February 2025 at a high-volume endocrine referral centre. During the study period, 3317 thyroid procedures were performed, and 2277 patients met the inclusion criteria and were stratified into conventional naked-eye surgery (NE) and combined NIRAF/ICGa groups (1956 vs. 321, respectively). The primary endpoint was immediate and permanent hypoparathyroidism. Secondary endpoints included hypocalcaemia, inadvertent parathyroid excision, operative time, and postoperative hospital stay. A subgroup analysis was performed in patients with thyroid malignancy. After matching, immediate hypoparathyroidism was significantly lower in the NIRAF/ICGa group (35.5% vs. 45.2%; p = 0.016), whereas permanent hypoparathyroidism showed a favourable non-significant reduction (2.2% vs. 4.7%; p = 0.129). Hypocalcaemia rates were similar between groups, while hospital stay was shorter in the NIRAF/ICGa group (p < 0.001), with comparable operative times. In the matched malignant subgroup, both immediate (38.6% vs. 50.3%; p = 0.045) and permanent hypoparathyroidism (0.7% vs. 5.5%; p = 0.036) were significantly lower in the NIRAF/ICGa group. Inadvertent parathyroid excision also showed a favourable trend after matching (16.5% vs. 21.8%; p = 0.109). Combined NIRAF/ICGa was associated with lower immediate hypoparathyroidism overall and lower immediate and permanent hypoparathyroidism in the matched malignant subgroup, without prolonging operative time.
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