The impact of near-infrared autofluorescence and indocyanine green fluorescence on surgical management of primary hyperparathyroidism.

Authors

Nathanaël Saison, Frédéric Triponez, Gianluca Donatini, Samuel Frey, Claire Nomine-Criqui, Eric Mirallié, Christophe Trésallet, Paulina Kuczma

Published in

Journal of visceral surgery. Aug 12, 2026. Epub Aug 12, 2026.

Abstract

Surgery constitutes the only curative treatment of primary hyperparathyroidism (PHPT). The difficulty in localizing all hyperfunctioning parathyroid glands can lead to the persistence of the disease and require a surgical reintervention. Complementary intraoperative tools for the localization of hyperfunctioning parathyroid glands remain, however, limited. The objective of this review is to evaluate the role of near-infrared autofluorescence (NIRAF) and fluorescence with indocyanine green (ICG) injection in the surgery of PHPT. NIRAF allows real-time visualization of the parathyroid glands without dye injection and has shown promising results for improving intraoperative detection of the parathyroids. Parathyroid adenomas appear to present specific autofluorescence characteristics. The impact of NIRAF on the cure rate, complication rate, and reduction of operative time in PHPT surgery remains currently uncertain. As the use of NIRAF in PHPT is still in its early stages, only a few studies have analyzed its impact on surgical outcomes. ICG shows promising results for the identification of parathyroid glands and could allow rapid detection of parathyroid adenomas, although this still needs to be validated in larger series. Its most established and relevant use currently remains the evaluation of vascularization and viability of the parathyroid remnant during a subtotal parathyroidectomy. Prospective studies evaluating the use of ICG in PHPT surgery still need to be conducted. The limitations of NIRAF and ICG techniques are the lack of standardized protocols and the additional cost. In conclusion, fluorescence imaging can facilitate the identification of normal and pathological parathyroid glands, increase the surgeon's confidence, and reduce the need for frozen section pathological examination, with a probably greater benefit for less experienced surgeons. Due to the recent emergence of fluorescence in PHPT and therefore an early stage of use, its main current limitations include the absence of standardized protocols and limited evidence regarding its impact on surgical performance and outcomes.

PMID:
42586861
Bibliographic data and abstract were imported from PubMed on 13 Aug 2026.

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