The use of Indocyanine green in endocrine surgery of the neck: A systematic review

BACKGROUND: The insufficient reliability of preoperative imaging technology and limited convenience of intraoperative visualizing techniques have been associated with difficulty in surgical navigation in neck endocrine surgery. Indocyanine green (ICG) fluorescence imaging has stood out as the real-time intraoperative guide amidst research for novel modalities, with an emerging use in endocrine surgery. METHODS: We performed a systematic review of the PubMed, Scopus and Embase databases, to identify published studies on parathyroid and thyroid operations employing ICG. Well-described articles were selected according to 7 criteria and analyzed per operation type and organ structure. RESULTS: Twenty-one articles matched our selection criteria. Dosage, equipment, and techniques are well-described in literature. ICG was found to significantly enhance the surgical experience and outcomes. Occasional discrepancy among studies was attributed to the lack of standard quantification of values and divergence of study designs. CONCLUSION: The most successful applications of ICG are: 1. delineation of hyperplastic or adenomatous or ectopic parathyroids, 2. decision making during subtotal parathyroidectomy, 3. preservation of parathyroid function in thyroid operations and 4. reoperation after failed past neck exploration. Future research is needed for standard quantification of fluorescence intensity and objective comparisons.