Document Detail


Minimally invasive focused parathyroidectomy without using intraoperative parathyroid hormone monitoring or gamma probe.
MedLine Citation:
PMID:  20083868     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Minimally invasive parathyroidectomy (MIP) is widely used worldwide for the treatment of primary hyperparathyroidism (pHPT). It is usually combined with a perioperative adjunct for high success rate. AIM: To demonstrate that MIP can be successfully performed in a selected group of patients with presumabally solitary adenoma as the cause of pHPT without using any perioperative adjuncts. SETTINGS AND DESIGN: A prospective data analysis of two surgeons' series from a teaching hospital in Turkey. MATERIALS AND METHODS: Of the 47 patients referred with a diagnosis of pHPT during January 2004-May 2008, 30(63%) patients with sporadic pHPT with presumed solitary adenoma were included for analysis. These patients underwent MIP via focused lateral (n=24) or anterior (n=6) approach. Preoperative localization was done using 99 mTc-labelled sestamibi scan and ultrasonography. Only patients with concordant tests for single adenoma were selected for MIP. Serum parathyroid hormone and calcium levels were measured postoperatively and at follow-up visits. STATISTICAL ANALYSIS: Parametric data presented were analyzed with Excel XP (Microsoft, Redmond, WA, USA). RESULTS: Barring one patient, all other patients were initially biochemically cured by MIP. One patient remained hypercalcemic, who was found to have a second adenoma at the second operation. During a mean follow-up of 16 (3-55) months, all patients were normocalcemic with a mean serum calcium level of 9.4 (8.9-10.2) mg/dl. Parathormone levels were persistantly elevated only in one patient (3.4%). No postoperative permanent complication was encountered. CONCLUSION: The results of MIP achieved in high-volume endocrine surgery centers can be replicated in low-volume center without any intraoperative adjuncts, in patients with overt clinical pHPT and concordant results of sestamibi and ultrasound.
Authors:
M Haciyanli; H Genc; N Damburaci; G Oruk; P Tutuncuoglu; N Erdogan
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of postgraduate medicine     Volume:  55     ISSN:  0022-3859     ISO Abbreviation:  J Postgrad Med     Publication Date:    2009 Oct-Dec
Date Detail:
Created Date:  2010-01-19     Completed Date:  2010-04-07     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  2985196R     Medline TA:  J Postgrad Med     Country:  India    
Other Details:
Languages:  eng     Pagination:  242-6     Citation Subset:  IM    
Affiliation:
Ataturk Training and Research Hospital, Second Surgery, Izmir, Turkey.
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MeSH Terms
Descriptor/Qualifier:
Adenoma / complications,  radionuclide imaging,  surgery*
Adult
Aged
Aged, 80 and over
Female
Follow-Up Studies
Hospitals, Teaching
Humans
Hyperparathyroidism, Primary / etiology,  surgery*,  ultrasonography
Male
Middle Aged
Parathyroid Hormone / blood*
Parathyroid Neoplasms / complications,  radionuclide imaging,  surgery*
Parathyroidectomy / methods*
Prospective Studies
Radiopharmaceuticals / diagnostic use
Surgery, Computer-Assisted / methods
Surgical Procedures, Minimally Invasive / methods*
Technetium Tc 99m Sestamibi / administration & dosage,  diagnostic use
Time Factors
Treatment Outcome
Turkey
Chemical
Reg. No./Substance:
0/Parathyroid Hormone; 0/Radiopharmaceuticals; 109581-73-9/Technetium Tc 99m Sestamibi
Comments/Corrections
Comment In:
J Postgrad Med. 2009 Oct-Dec;55(4):239-40   [PMID:  20083866 ]

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


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