Autofluorescence of the parathyroid glands during total thyroidectomy. Review of systematic reviews

Summary Introduction and Objective This study reviews the use of near-infrared autofluorescence (NIRAF) for identifying parathyroid glands during total thyroidectomy. The main goal is to evaluate whether using NIRAF reduces the incidence of postoperative hypocalcemia, a common complication of thyroid surgery. The study analyzes previously published meta-analyses to assess the effectiveness of NIRAF compared to traditional visual identification methods. The preservation of parathyroid glands during thyroid surgery is essential to prevent hypoparathyroidism and consequent hypocalcemia. Methods The research involved a review of systematic reviews and meta-analyses found in PubMed, WoS, and the Cochrane Library databases. Three meta-analyses that included studies on total thyroidectomy with and without NIRAF were selected. These meta-analyses evaluated transient and permanent postoperative hypocalcemia. The data from 15 studies included in the meta-analyses were extracted and statistically reanalyzed (meta-meta-analysis). The statistical analysis was performed using the ESCI statistical package of the JAMOVI program and METAFOR by JASP. The PRISMA guidelines were followed. Results The use of NIRAF during total thyroidectomy was associated with a significantly lower incidence of both global and transient hypocalcemia. The prevalence of permanent hypocalcemia was also lower in the NIRAF group, but the difference was not statistically significant. The meta-meta-analysis showed a statistically significant association between the use of NIRAF and a reduction in hypocalcemia. There was moderate to high heterogeneity in errors and possible asymmetry in the data for global and transient hypocalcemia, but not for permanent hypocalcemia. Conclusions NIRAF is a useful tool for identifying and preserving parathyroid glands during total thyroidectomy, and its use is associated with a reduced risk of postoperative hypocalcemia. The current evidence supports the use of NIRAF, although the strength of the recommendation is weak because of heterogeneity, risk of bias, and inconsistent results among the studies. More well-designed studies are needed to confirm these findings and establish NIRAF as a standard.