Near-infrared autofluorescence versus visual identification during parathyroidectomy: a systematic review and meta-analysis of surgical outcomes

Introduction Near-infrared autofluorescence (NIRAF) is an emerging adjunctive tool that facilitates intraoperative identification of parathyroid glands. Although it has shown promise in the setting of thyroidectomy, its role in parathyroidectomy for primary hyperparathyroidism (PHPT) remains unclear. Methods A systematic review was conducted according to PRISMA guidelines. Four databases were searched to identify studies comparing NIRAF with conventional visual identification of parathyroid glands during parathyroidectomy. The primary outcome was cure rates and secondary outcomes included operative time and the number of parathyroid glands identified. Methodological quality was assessed using Cochrane RoB2 and the Newcastle-Ottawa tools. Meta-analysis was performed using a random effects model. Results Three studies comprising of 522 patients were included: randomized controlled trials and one observational cohort study. Meta-analysis showed a non-significant improvement in cure rates with NIRAF (RR 1.06, 95% CI: 1.02-1.10, p = 0.21). Mean operative time was reduced by 2.1 minutes with NIRAF (95% CI -4.76-9.0, p = 0.55) and the mean number of parathyroid glands identified increased by 0.12 per patient (95% CI -0.21-0.46, p = 0.46). Neither of the secondary outcomes reached statistical significance. Heterogeneity was moderate to high across the outcomes. Conclusion Although NIRAF has proved promising in the setting of thyroidectomy, in the setting of parathyroidectomy for PHPT it did not offer statistically significant improvements in surgical outcomes. While the technology appears safe and promising, its impact on cure rates remains uncertain. Larger, high quality randomized controlled trials (RCTs) are warranted to define the role of NIRAF in parathyroid surgery more clearly.