Initial experience of intraoperative identification of parathyroid glands with elastic scattering spectroscopy
Gillis, Justin Lee
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BACKGROUND: Postoperative hypoparathyroidism due to damage to the parathyroid glands during a thyroidectomy is a well-known surgical complication. The current gold standard intraoperative method for identifying parathyroid glands is surgical judgment; other methods are limited in both their sensitivity and convenience. There is a clear need for an objective diagnostic tool that is effective in its identification of the parathyroid glands and of their viability. We hypothesized that an intraoperative tool using Elastic Scattering Spectroscopy (ESS) has the potential to differentiate optical signatures of the parathyroid gland from surrounding tissues in real-time. METHODS: ESS optical signatures were collected intraoperatively from perfused parathyroid, thyroid, fat, muscle, and nerve tissue during thyroidectomy. The ESS data was collected using a portable, handheld, noninvasive, "cold" fiber optic probe able to detect spectra in a non-ionizing, broadband spectrum of light (320 to 920 nm). Five measurements were collected at each tissue site over a total of 1.2 seconds. Visual analysis of tissue was analyzed and compared to pathology, and spectral measurements attained with ESS. RESULTS: No complications resulted from the use of the ESS probe. Of the 10 parathyroid glands evaluated to be at risk in the study, the optical probe utilizing ESS was able to detect unique spectral features associated with the parathyroid gland. All 10 parathyroid glands are optically differentiable from surrounding tissues with ESS. CONCLUSIONS: Utilizing spectroscopy in the form of a hand-held probe is feasible for intraoperative differentiation between tissue types. Preliminary results of this spectral technique warrant further investigation. If successful, implementation of a portable ESS probe to identify the parathyroid tissue during endocrine surgical procedures could reduce surgical complications and improve patient safety.