Comment on: Parathyroid vascular anatomy using intraoperative mapping angiography: the PARATLAS study

Correspondence to: Sabaretnam Mayilvaganan (drretnam@gmail.com)

Additional Professor

Department of Endocrine Surgery

Sanjay Gandhi Postgraduate Institute of Medical Sciences

India

_____

BJS, https://doi.org/10.1093/bjs/znae307, published 11 March 2025

_____

We discussed the recent article by Benmiloud et al.1 in our department journal club. The authors are to be commended for this elegant, simple and meticulously conducted study, which offers crucial insights into the vascular anatomy of the parathyroid glands (PGs). The classification of six distinct vascular patterns and their correlation with the preservation difficulty during thyroidectomy is not only innovative, but also has significant clinical relevance for surgeons. By delineating the vascular trajectories, particularly the emphasis on the clustering of superior PG vessels around Zuckerkandl’s tubercle and the anterior dispersion of inferior PG vessels, this study provides a practical roadmap for endocrine surgeons aiming to preserve parathyroid function. The integration of fluorescence imaging into endocrine surgery is rapidly evolving and many centres have already adapted this technology2,3. This study reinforces the value of intraoperative mapping angiography, not only as a tool for real-time visualization, but also as a method to inform surgical decision-making. We have a few queries that might interest future readers.

It would be of interest to know whether the vascular classification proposed correlated with postoperative parathyroid function, especially in high-volume or minimally invasive settings with increased magnification such as robotic parathyroidectomy. Did the authors notice any issues with the use of dye, especially indocyanine green? Additionally, the reproducibility of these vascular patterns across diverse anatomical and pathological variants (e.g., in Graves’ disease or large goitres) may be worth exploring as an aid to surgeons.