BACKGROUND: Improvements in the accuracy of preoperative localization and the availability of the rapid parathyroid hormone assay have permitted minimally invasive parathyroidectomy in patients with primary hyperparathyoidism. HYPOTHESIS: The use of intraoperative radioguidance is beneficial during targeted parathyroid operations. DESIGN: A retrospective analysis of a prospective database of patients. SETTING: Tertiary care referral center. PATIENTS: During a 2(1/2)-year period, 130 patients underwent minimally invasive, targeted parathyroidectomy with intraoperative monitoring of the parathyroid hormone level. Of these, 60 patients underwent radioguided parathyroidectomy. Prior to surgery, a solitary parathyroid adenoma was visualized on technetium Tc 99m sestamibi scintigraphy in all patients selected for radioguided parathyroidectomy. A gamma probe was used to guide the surgical dissection. RESULTS: All patients were cured following radioguided parathyroidectomy. In 29 patients (48%), the probe provided confusing or inaccurate information; however, a unilateral neck exploration with excision of a parathyroid adenoma was successfully completed in each of these patients. Forty-three cases were completed under local anesthesia and 85% were discharged home on the same day of surgery. There was 1 temporary recurrent laryngeal nerve palsy. CONCLUSION: In the era of improved preoperative localization and intraoperative parathyroid hormone monitoring, the routine use of radioguidance is not recommended during parathyroidectomy.
BACKGROUND: Improvements in the accuracy of preoperative localization and the availability of the rapid parathyroid hormone assay have permitted minimally invasive parathyroidectomy in patients with primary hyperparathyoidism. HYPOTHESIS: The use of intraoperative radioguidance is beneficial during targeted parathyroid operations. DESIGN: A retrospective analysis of a prospective database of patients. SETTING: Tertiary care referral center. PATIENTS: During a 2(1/2)-year period, 130 patients underwent minimally invasive, targeted parathyroidectomy with intraoperative monitoring of the parathyroid hormone level. Of these, 60 patients underwent radioguided parathyroidectomy. Prior to surgery, a solitary parathyroid adenoma was visualized on technetium Tc 99m sestamibi scintigraphy in all patients selected for radioguided parathyroidectomy. A gamma probe was used to guide the surgical dissection. RESULTS: All patients were cured following radioguided parathyroidectomy. In 29 patients (48%), the probe provided confusing or inaccurate information; however, a unilateral neck exploration with excision of a parathyroid adenoma was successfully completed in each of these patients. Forty-three cases were completed under local anesthesia and 85% were discharged home on the same day of surgery. There was 1 temporary recurrent laryngeal nerve palsy. CONCLUSION: In the era of improved preoperative localization and intraoperative parathyroid hormone monitoring, the routine use of radioguidance is not recommended during parathyroidectomy.
Authors: Yash R Somnay; Eric Weinlander; Amal Alfhefdi; David Schneider; Rebecca S Sippel; Herbert Chen Journal: J Surg Res Date: 2015-02-19 Impact factor: 2.192
Authors: Linwah Yip; Daniel A Pryma; John H Yim; Mohamed A Virji; Sally E Carty; Jennifer B Ogilvie Journal: World J Surg Date: 2008-05 Impact factor: 3.352