The use of indocyanine green fluorescence dye in adrenal, thyroid, and parathyroid glands surgery: a prospective cohort study.

BACKGROUND: Indocyanine green (ICG) fluorescence imaging is increasingly employed in endocrine surgery to enhance anatomical precision and intraoperative decision-making. This study evaluates its role across thyroidectomy, parathyroidectomy, and laparoscopic adrenalectomy. METHODS: A prospective cohort study was conducted over 24 months across two tertiary endocrine surgery centers. A total of 120 patients undergoing elective thyroidectomy (n=60), parathyroidectomy (n=40), or laparoscopic adrenalectomy (n=20) were enrolled and divided into ICG-assisted and control groups. ICG fluorescence was used for real-time visualisation of vascular structures and assessment of tissue viability. RESULTS: In the thyroidectomy, group, ICG group demonstrated a significantly lower rate of transient hypoparathyroidism (16.7% vs. 43.3%, p=0.047), with selective auto-transplantation guided by perfusion scoring. Permanent hypoparathyroidism was also lower (6.7% vs. 16.7%), though not statistically significant. During parathyroidectomy, ICG enabled accurate localisation and vascular confirmation in all patients, with 100% cure rates in both groups. In adrenalectomy, ICG allowed early adrenal vein identification in 30% of ICG-assisted cases and enhanced anatomical clarity, particularly in complex scenarios like subtotal adrenalectomy. CONCLUSION: ICG fluorescence is a safe and effective adjunct in endocrine surgery. It supports real-time intraoperative decision-making by enabling dynamic assessment of tissue perfusion and vascular anatomy. Wider adoption and standardised protocols may further improve safety and surgical precision, particularly in high-risk procedures.