Use of autofluorescence and/or indocyanine green in thyroid surgery: recommendations by the European Society of Endocrine Surgeons (ESES)
In brief
Review of 9,322 thyroid surgeries finds potential benefit from parathyroid imaging
A review of 34 studies, including 11 randomized trials, found promising results for near-infrared imaging with or without indocyanine green in reducing postoperative hypoparathyroidism, inadvertent gland removal, and autotransplantation. The European Society of Endocrine Surgeons used the evidence and expert consensus to develop guidance, but the abstract gives no effect sizes or specific recommendations.
- Journal
- The British journal of surgery (Q1)
- Published
- 5 October 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Klaas Van Den Heede, Frédéric Triponez, Orhan Agcaoglu, Marcin Barczynski, Gianluca Donatini, Ioannis Koutelidakis, et al.
- PMID
- 42929023
- DOI
- 10.1093/bjs/znag118
Why clinicians should know about it
- Picked for Breast and Endocrine Surgery (paper of the day, 27 October 2026): Thyroid surgery guidance on parathyroid preservation and hypoparathyroidism
Abstract
BACKGROUND: Postoperative hypoparathyroidism remains the most frequent complication after total thyroidectomy. Recently, near-infrared autofluorescence (NIRAF) imaging with or without indocyanine green (ICG) was introduced to evaluate parathyroid glands during surgery. The aim of this paper is to provide recommendations by the European Society of Endocrine Surgeons (ESES) regarding its use in thyroid surgery based on a scoping review and meta-analysis. METHODS: A working group of experts was created by the ESES. A systematic literature search was performed, using MEDLINE® (PubMed), up to 31 December 2024. Studies were included if a comparative group was used to evaluate short- and long-term postoperative hypoparathyroidism, autotransplantation rates, and/or inadvertent parathyroid gland removal. The results were pooled in a random-effects meta-analysis. Subgroup analyses were performed to assess the impact of NIRAF with or without ICG, as well as central lymph node neck dissection. Recommendations were created among all co-authors and discussed at the 11th ESES conference. A modified Delphi online voting process amongst all members approved all recommendations. RESULTS: After screening 335 abstracts, there were 34 studies, with a total of 9322 patients, that met the inclusion criteria. These were published between 2017 and 2024 and included 11 RCTs. Meta-analyses showed promising results for NIRAF and ICG with regard to immediate and permanent hypoparathyroidism, inadvertent removal proportions, and autotransplantation proportions. The quality of evidence was rated as 'moderate' for most of the recommendations with good quality of evidence for most questions. CONCLUSION: These ESES recommendations provide guidance for the use of NIRAF with or without ICG based on a scoping review of the literature, meta-analyses, and expert opinion.
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.