1257 Literature Review: Precision in Parathyroid Surgery: Unveiling New Frontiers with Robotic Assistance and Indocyanine Green Fluorescence Imaging

Aim This review delves into the effectiveness of indocyanine green (ICG) fluorescence for visually identifying hyperparathyroidism in robot-assisted parathyroidectomy, utilising FireflyTM technology. Concurrently, a comparative analysis between robot-assisted and open parathyroidectomy to discern clinical nuances between the two approaches. Method In a cohort of 37 primary hyperparathyroidism patients (open parathyroidectomy n=31, robot-assisted n=6), both groups used pre-op localization and IOPTH assays. ICG was selectively administered in robot-assisted. In another literature, BABA robotic parathyroidectomy (n=22, Dec 2013–Aug 2015), Firefly in da Vinci Si guided ICG for parathyroid identification. Post-op days 0, 1, 2, and 14 monitored parathyroid hormone levels. Propensity score matching formed a control group for age, gender, tumour size, and operation type, assessing parathyroid functionality. Results The robot group exhibited persistent fluorescence in pathologic parathyroids under near-infrared vision. Post-removal, IOPTH normalised in all robot group patients. Despite a superior cosmetic outcome, the robot group experienced longer hospital stays (3.0 ± 0.0 vs. 1.8 ± 1.2 days, p < 0.001) and extended operation times (152.5 ± 23.6 vs. 91.1 ± 69.1 min, p = 0.001) compared to the open parathyroidectomy. After 6 months, both groups demonstrated normalised PTH, calcium, and ionised calcium levels. However, in BABA robotic thyroidectomy, ICG group had significantly less inadvertent parathyroidectomy than the control (0% vs. 15.9%, P = 0.048). Conclusions Robot-assisted parathyroidectomy with ICG facilitates precise identification of pathologic glands, offering a superior cosmetic outcome. However, clinical outcomes do not surpass those of conventional open parathyroidectomy. This review explains the nuanced approach to PHPT surgery, integrating robotics for enhanced precision and patient outcomes.