Abstract Background Patients with primary hyperparathyroidism (pHPT) can benefit from focused surgery. However, frozen section(FS) and intraoperative parathyroid hormone(ioPTH) are employed to confirm success of surgery. This may increase length and cost per procedure. Our study assesses the impact of NIRAF in patients with pHPT for these variables. Methods All patients undergoing focused parathyroidectomy for pHPT with concordant ultrasound (US) and 99mTc-sestamibi Scintiscan localization between 2021 and 2025 were included in study groups: autofluorescence(AF) or control(CG). In AF group, autofluorescence pattern of the adenoma was considered successful and concluded the procedure. In the CG, after adenoma removal, ioPTH analysis and frozen section were performed to assess success of procedure. Results Overall, 193 patients were operated: 67 in CG and 126 in AF. In CG, the median operating time was 67 minutes, compared to 35 minutes in AF(p 0.001). Pathological report confirmed the AF typical heterogeneous pattern findings in 123/126 cases (97.6%), while in 3 cases a lesion, not showing the typical AF pattern of an adenoma, was removed but was not parathyroid tissue (2 lymph nodes and an ectopic thyroid nodule). Use of AF may avoid ioPTH(50€), frozen section(50€) and saves 30’ of surgery time (250€ per hour). Conclusions The use of NIRAF in patients with pHPT with concordant preoperative localization imaging reduces the overall surgical time by 50%. Overall costs may drop by 200–250 € per patient by avoiding frozen section and ioPTH. The saved time may allow more procedures per working day.
Donatini et al. (Fri,) studied this question.