OPTIMIZATION OF MINIMALLY INVA SIVE RADIO-GUIDED PARATHYROIDECTOMY: THE IMPORTANCE OF NECK ULTRASONOGRAPHY AND INTRAOPERATIVE PARATHYROID HORMONE ASSAY

• Published in: Endocrine practice Vol. 14; no. 7; p. 856
• Main Authors: Harrell, R Mack, Bimston, David N
• Format: Journal Article
• Language: English
• Published: Jacksonville Elsevier Limited 01.10.2008
• ISSN: 1530-891X; 1934-2403

The objective of this study was to determine whether close collaboration between a neck ultrasound-certified endocrinologist and a skilled endocrine surgeon can optimize minimally invasive radio-guided parathyroidectomy (MIRP) surgical outcomes. Outcome data were collected on patients with primary hyperparathyroidism whom we intended to treat with MIRP at the induction of anesthesia between Oct 1, 2005, and Dec 31, 2007. Patients underwent preoperative gamma camera sestamibi scanning (GCSS), intraoperative gamma probe sestamibi scanning (IOSS), and preoperative neck ultrasonography. Intraoperative parathyroid hormone monitoring was performed. During the study period, MIRP was planned for 46 patients. Of the 46 patients, 39 had preoperative neck ultrasonography; 7 underwent evaluation by an endocrinologist or internist who was not ultrasound certified and they therefore did not undergo preoperative ultrasonography. IOSS correctly identified 1 adenomatous gland in 38 of 46 patients (83%), while GCSS correctly localized 1 adenomatous gland in 30 of 46 patients (65%). In 11 GCSS-negative patients, IOSS identified the abnormal gland in 7 (64%), while ultrasonography identified the abnormal gland in 8 (73%).