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Potential role for carbon nanoparticles identification and preservation in situ of parathyroid glands during total thyroidectomy and central compartment node dissection.
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2015
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Surgical OncologyEngineeringParathyroid DiseaseCarbon Nanoparticles IdentificationNanotoxicologySurgeryParathyroid GlandBiomedical EngineeringChemistryOncologySurgical PathologyParathyroid HormonePotential RoleRadiation OncologyEndocrine SurgeryTotal ThyroidectomyCarbon NanoparticlesNanomaterialsThyroid DiseaseThyroid HormoneMedicineThyroid Cancer
e17048 Background: Patients undergoing thyroid surgery are at risk for hypoparathyroidism. We hypothesized that carbon nanoparticles identification of parathyroid glands might help maximize parathyroid preservation and reduce postoperative hypoparathyroidism. Methods: Patients with thyroid cancer who underwent total thyroidectomy and central compartment node dissection (CCND) were randomly assigned to receive intraoperative injection of carbon nanoparticles (CN) or not for identifying and preserving normal parathyroid glands. We compared the levels of parathyroid hormone and serum calcium before surgery and at day 1, 3 and 30 after surgery between the 2 groups, as well as postoperative thyroid pathological and lymph node dissection results. Results: A total of 100 patients with thyroid carcinoma were included in the research, 50 in CN group and 50 in control group. There was no significantly difference for preoperative and postoperative PTH levels between the CN and control group (p > 0.05). The levels of AASC before surgery and at day 1and 1 month after surgery did not reach the significant difference between the two groups (p > 0.05). However, the patients in CN group had the higher level of AASC at day 3 after surgery than those in control group (p = 0.044). Transient postoperative hypoparathyroidism occurred in 24(48%) patients in CN group and 28(56%) in control groups, respectively (p = 0.423). The incidence of transient postoperative hypocalcemia was 20% (10/50) in CN group and 24% (12/50) in control groups, respectively (p = 0.629). Conclusions: Carbon nanoparticles can make the thyroid gland and the central lymph node black-stained, but no-stained for parathyroid glands. After rapidly identifying parathyroid and distinguishing it from thyroid and lymph nodes by carbon nanoparticles, complete lymph node dissection and preservation of parathyroid glands become feasible during total thyroidectomy with neck lymph node dissection. After identification, strict adherence to capsular dissection remains essential for safe preservation in situ of the parathyroid glands and their blood supply.