Document Detail


Advantages of a targeted approach in minimally invasive radioguided parathyroidectomy surgery for primary hyperparathyroidism.
MedLine Citation:
PMID:  16540904     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: In a large series of patients, we associated the need for preoperative parathyroid hormone (PTH) and calcium levels as a vital component in our approach to the radioguided minimally invasive parathyroidectomy (MIRP) procedure. Our objective was to determine whether these preoperative levels indeed complemented the procedure. Our study also included a postoperative assessment of excised gland volume and length of operation. STUDY DESIGN: This was a prospective cohort study. METHODS:: One hundred seventy-three patients with primary hyperparathyroidism enrolled in our radioguided MIRP protocol. Patients were divided into groups based on the results of sestamibi scans. Comparisons were made between these results and the assessed preoperative PTH and calcium levels and the postoperative excised gland volume and length of operation. RESULTS: PTH and calcium levels did not statistically relate with the likelihood of having a "positive," "equivocal," or "negative" sestamibi scan, but the volume of excised gland was significantly different among the three groups (P < .01). There was no significant difference between positive and equivocal scans (P = .40). Operative time was significantly different between positive and equivocal scans (P < .01), positive and negative scans (P < .01), and equivocal and negative scans (P < .01). CONCLUSIONS: Routine preoperative PTH and calcium levels are necessary for the biologic diagnosis of hyperparathyroidism, but they do not appear to relate to the outcome of a sestamibi scan and therefore do not complement the radioguided MIRP procedure. Because the size of the affected gland, however, did correlate with a positive sestamibi scan, we conclude that as the volume of the gland increases, so does the likelihood of a successfully chosen minimally invasive surgical approach.
Authors:
Jennifer A Grady; Jeffrey M Bumpous; Muffin M Fleming; Michael B Flynn; Elliott Turbiner; Eric J Lentsch; Craig H Ziegler
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The Laryngoscope     Volume:  116     ISSN:  0023-852X     ISO Abbreviation:  Laryngoscope     Publication Date:  2006 Mar 
Date Detail:
Created Date:  2006-03-16     Completed Date:  2006-04-06     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8607378     Medline TA:  Laryngoscope     Country:  United States    
Other Details:
Languages:  eng     Pagination:  431-5     Citation Subset:  IM    
Affiliation:
Division of Otolaryngology, Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky 40202, USA.
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MeSH Terms
Descriptor/Qualifier:
Female
Follow-Up Studies
Humans
Hyperparathyroidism, Primary / radionuclide imaging,  surgery*
Intraoperative Period
Male
Middle Aged
Parathyroidectomy / methods*
Prospective Studies
Radiopharmaceuticals / diagnostic use*
Surgical Procedures, Minimally Invasive / methods*
Technetium Tc 99m Sestamibi / diagnostic use*
Tomography, Emission-Computed
Treatment Outcome
Chemical
Reg. No./Substance:
0/Radiopharmaceuticals; 109581-73-9/Technetium Tc 99m Sestamibi

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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