Minimally invasive, radioguided surgery for primary hyperparathyroidism

• Published in: Annals of surgical oncology Vol. 8; no. 10; pp. 856 - 860
• Main Authors: McGreal, G, Winter, D C, Sookhai, S, Evoy, D, Ryan, M, O'Sullivan, G C, Redmond, H P
• Format: Journal Article
• Language: English
• Published: United States Springer Nature B.V 01.12.2001
• Subjects: Adenoma - diagnostic imaging; Adenoma - surgery; Adult; Aged; Aged, 80 and over; Female; Humans; Hyperparathyroidism - diagnostic imaging; Hyperparathyroidism - surgery; Male; Middle Aged; Minimally Invasive Surgical Procedures; Parathyroidectomy - methods; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Sestamibi
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1007/s10434-001-0856-0

Primary hyperparathyroidism affects 1 in 700 individuals in the United States. A single adenoma is responsible in over 85% of cases. Surgery remains the most effective treatment. This study was designed to assess the feasibility of minimally invasive radioguided parathyroidectomy (MIRP) with confirmation of excision by ex vivo radioactivity alone. Seventy-five consecutive patients with primary hyperparathyroidism were prospectively studied. Following sestamibi scan, patients underwent unilateral neck exploration guided by a handheld gamma probe, which was also used to measure ex vivo radioactivity of excised tissue. The sestamibi scan was positive in 88% of the patients. A small incision (mean, 3.2+/-0.3 cm) was sufficient. Ectopic gland sites were localized in five patients with positive scans and single adenomas. Mean operative time was 48 minutes (range, 15-125 minutes), with shorter procedures after the initial 20 cases (mean, 24 vs. 72 minutes; P < .01). Radioguided parathyroidectomy was successful in 97%, with a mean follow-up of 11 months (range, 1-26 months). As noted previously, adenomatous parathyroid glands contained more than 20% of the background radioactivity. MIRP is a feasible alternative to bilateral dissection with the advantages of guided dissection and rapid confirmation, and may become the procedure of choice for primary hyperparathyroidism.