Intraoperative localization of the parathyroid glands with indocyanine green and Firefly(R) technology during BABA robotic thyroidectomy

Hyeong Won Yu, Joon Woo Chung, Jin Wook Yi, Ra Yeong Song, Joon Hyop Lee, Hyungju Kwon, Su jin Kim, Young Jun Chai, June Young Choi, Kyu Eun Lee

Research output: Contribution to journalArticlepeer-review

56 Scopus citations


Background: It is unclear whether near-infrared (NIR) light-induced indocyanine green (ICG) fluorescence can effectively identify, and thus permit the preservation of, parathyroid glands in bilateral axillo-breast approach (BABA) robotic thyroidectomy. This case–control study with a prospectively recruited consecutive series and a retrospectively selected control group assessed the usefulness of ICG with Firefly(R) technology to identify the parathyroid glands intraoperatively during BABA robotic thyroidectomy. Methods: All consecutive patients (N = 22) who were scheduled to undergo BABA robotic thyroidectomy for papillary thyroid carcinoma in December 2013–August 2015 and met the study eligibility criteria were recruited prospectively. ICG fluorescence was used with the Firefly system (NIR illuminator: 805 nm; filter: 825 nm) integrated in the da Vinci Si robot system to identify the lower parathyroid glands. Parathyroid hormone levels were recorded on postoperative days 0, 1, 2, and 14. Propensity score matching was used to identify an age-, gender-, tumor size-, and operation type-matched group of control patients who underwent BABA robotic thyroidectomy without the Firefly system. The two groups were compared in terms of parathyroid-related outcomes. Results: ICG fluorescence-mediated identification of the parathyroid and thyroid glands required on average (range) 203 ± 89 (125–331) and 207 ± 112 (130–356) s, respectively. The mean (range) fluorescence duration in these glands was 20.8 ± 6.0 (16.6–35.8) and 20.1 ± 7.3 (15.5–33.8) min, respectively. The ICG group had a significantly lower rate of incidental parathyroidectomy than the control group (0 vs. 15.9%, P = 0.048). Conclusions: ICG with NIR light may feasibly and safely identify the parathyroid glands in BABA robotic thyroidectomy.

Original languageEnglish
Pages (from-to)3020-3027
Number of pages8
JournalSurgical Endoscopy
Issue number7
StatePublished - 1 Jul 2017


  • Bilateral axillo-breast approach
  • Firefly technology
  • Indocyanine green fluorescence
  • Near infrared
  • Parathyroid glands
  • Robotic thyroidectomy


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