Preoperative Imaging Localization and Intraoperative Indocyanine Green-Enhanced Fluorescence Guidance for Focused Transoral Endoscopic Parathyroidectomy Vestibular Approach
Bibliographic record
Abstract
Background: Focused parathyroidectomy evolves the preferable surgical policy for primary hyperparathyroidism (PHPT).1–3 Transoral endoscopic vestibular approach furnishes a scarless choice of minimal invasive parathyroidectomy. Preoperative technetium-99m sestamibi (Tc-99m MIBI) scintigraphy, ultrasonography, and intraoperative indocyanine green (ICG)-enhanced fluorescence contribute to localization of parathyroid gland4 and guidance for parathyroidectomy accurately. It assists in limited dissection, cosmetic achievement, and durable cure during transoral endoscopic vestibular approach for focused parathyroidectomy. Materials and Methods: The preparation and settings are the same as transoral endoscopic vestibular approach, which has been described before by Anuwong et al.5,6 In the present patient, we obtained limited subplatysma muscle flap dissection followed by smaller working space creation for facilitating left inferior lateral approach to expose the target area of interest instead of splitting the strap muscles at midline and devascularizing or retracting the thyroid lobe based on preoperative Technetium-99m sestamibi (99mTc MIBI) scintigraphy and ultrasonic localization. ICG (Diagnogreen Injection, 2.5 mg/mL) was given in a fixed dose parenterally.7 Intraoperative ICG-enhanced endoscopic fluorescence imaging systems 1588 AIM (Stryker, Kalamazoo, MI) helped in localizing and confirming the left lower parathyroid lesion during parathyroidectomy. Another endoscopic fluorescence platform PINPOINT (Novadaq, Mississauga, ON, Canada) utilized in PHPT patients brought equal efficacy. Results and Conclusions: This video illustrates combined preoperative 99mTc MIBI scintigraphy and ultrasonography with intraoperative ICG-enhanced fluorescence conducting in guidance for focused transoral endoscopic parathyroidectomy vestibular approach. It optimizes distinct horizon of the parathyroid, fulfills excellent cosmetic outcomes, and obtains limited dissection. No competing financial interests exist. Runtime of video: 7 mins 46 secs
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".