Comparison of Camera-Based vs. Contact Parathyroid Autofluorescence Systems in Preventing Postoperative Hypocalcemia After Total Thyroidectomy: A Systematic Review

AbstractIntroductionPostoperative hypocalcemia is a common complication of total thyroidectomy, primarily due to inadvertent injury or removal of the parathyroid glands. Near-infrared autofluorescence (NIRAF) has emerged as an intraoperative tool for real-time gland identification without the use of contrast agents, potentially reducing this complication. Two main modalities exist: camera-based (non-contact) systems and contact probe-based systems, but their comparative clinical effectiveness remains unclear.ObjectiveTo compare the effectiveness of camera-based versus contact parathyroid autofluorescence systems in reducing the prevalence of hypocalcemia secondary to hypoparathyroidism in patients undergoing total thyroidectomy.MethodsA systematic review was conducted following PRISMA guidelines. Included studies consisted of randomized clinical trials, meta-analyses, and retrospective cohorts involving patients undergoing total thyroidectomy, with explicit hypocalcemia outcomes.ResultsAmong the 10 analyzed studies, several demonstrated that NIRAF significantly reduces transient hypocalcemia compared to conventional approaches. However, no study directly compared camera-based and contact systems. Camera-based systems were studied more frequently. Some reports showed a reduction in transient hypocalcemia rates of up to 17% compared to controls.ConclusionsCurrent evidence supports the general use of NIRAF in reducing postoperative hypocalcemia after total thyroidectomy, particularly for transient cases. However, there is no direct clinical evidence comparing contact and camera-based systems. Comparative clinical trials are needed to determine their relative efficacy.