Near-infrared Autofluorescence Probe Versus Visual Identification for Parathyroid Detection and Functional Preservation During Total Thyroidectomy: A Randomized Controlled Trial
In brief
PTeye near-infrared probe cuts transient hypoparathyroidism by two-thirds in junior surgeons
In a randomized trial of 154 total thyroidectomies, PTeye guidance increased identified parathyroid glands (average 3.8 vs 2.7) and raised the rate of preserving three to four glands in situ to 99% versus 87%. Among junior surgeons, transient hypoparathyroidism fell from 55% to 20%, while permanent rates were unchanged.
- Journal
- Annals of surgery (Q1)
- Published
- 25 August 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Marcin Barczyński, Agnieszka Pac, Karolina Krakowska, Katarzyna Kłodziejska, Mateusz Dworak, Aleksander Konturek
- PMID
- 42638312
- DOI
- 10.1097/SLA.0000000000007180
Why clinicians should know about it
- Picked for Breast and Endocrine Surgery (top studies of the week, 30 August 2026): PTeye NIRAF improves parathyroid identification and reduces transient hypoparathyroidism
Abstract
OBJECTIVE: To assess whether PTeye-guided identification increases the number of parathyroid glands (PGs) preserved in situ and reduces hypoparathyroidism compared with visual identification alone. BACKGROUND: Injury or inadvertent removal of PGs during thyroidectomy is the main cause of postoperative hypoparathyroidism. Reliance on visual inspection makes intraoperative PG identification difficult. Probe-based near-infrared autofluorescence (NIRAF) systems such as PTeye provide real-time, tissue-specific feedback that may enhance PG detection and preservation. METHODS: In this single-center, prospective, randomized trial, patients undergoing first-time total thyroidectomy were allocated to PTeye-assisted or visual PG identification. Procedures were performed by 2 senior and 3 junior surgeons. The primary outcome was the number of PGs identified. Secondary outcomes included inadvertent parathyroidectomy, autotransplantation, and transient and last follow-up hypoparathyroidism. RESULTS: Among 154 randomized patients (77 per group; mean age 53.4±14.3 y; 84.4% female), PTeye increased the mean number of PGs identified (3.81 vs. 2.73; P<0.001) and the proportion with 3-4 PGs preserved in situ (98.7% vs. 87.0%; P=0.004). Inadvertent parathyroidectomy was less frequent with PTeye (5.2% vs. 20.8%; P=0.004). Junior surgeons performed more autotransplantations than senior surgeons when using PTeye (33.3% vs. 10.5%; P=0.015). Female sex (P=0.047), ≤2 PGs preserved (P=0.008), and autotransplantation (P=0.010) predicted low postoperative day-1 parathormone serum level. Among junior surgeons, transient hypoparathyroidism was lower with PTeye (20.5% vs. 55.2%; P<0.001), with no difference among senior surgeons. Permanent hypoparathyroidism rates were similar between groups. CONCLUSIONS: PTeye-guided NIRAF improves PG identification and in situ preservation and reduces transient hypoparathyroidism, particularly for junior surgeons, without affecting permanent hypoparathyroidism.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.