Document Detail

Minimally invasive parathyroidectomy without intraoperative localization.
MedLine Citation:
PMID:  11730217     Owner:  NLM     Status:  MEDLINE    
Minimally invasive parathyroidectomy (MIP) is gaining popularity as an alternative to traditional bilateral exploration for patients with primary hyperparathyroidism. The success of MIP relies on the ability of preoperative and intraoperative localization studies to guide a directed exploration for resection of a diseased gland. We hypothesize that excellent results can be achieved with MIP when only technetium-99m sestamibi (MIBI) is used for localization. We conducted a prospective analysis of all patients presenting with a biochemical diagnosis of primary hyperparathyroidism between January 1997 and November 2000. Patients meeting inclusion criteria were given a choice of MIP and directed exploration versus traditional bilateral exploration. Fifty patients chose MIP. Three patients who chose MIP had a negative MIBI, which left 47 patients in the primary study group. The MIBI correctly identified a parathyroid adenoma in 42 patients (89.3%). In two other patients MIBI was inaccurate; however, directed exploration was successfully converted to a bilateral exploration. Overall 44 of 47 (93.6%) patients in the study group were rendered normocalcemic after the initial operation. Three patients experienced persistent hypercalcemia and subsequently underwent successful bilateral exploration. Including those patients choosing a bilateral exploration, a total of 59 positive MIBI scans were evaluated. There were 54 true positives (positive predictive value 91.5%), and if all patients had chosen a MIP 94.9 per cent would have been successfully treated at the initial operation. Mean operative time for MIP was 54.6 minutes, and in 32 patients (68.1%) MIP was performed with local anesthesia and sedation. Twenty-six patients (55.3%) were discharged the same day of the procedure. There were no significant complications in any group analyzed. We conclude that MIP can be successfully performed on the basis of a positive MIBI scan. The present study highlighting many of the advantages of MIP questions the necessity of additional adjuncts such as intraoperative parathyroid hormone measurement and gamma-probe localization.
L R Sprouse; S M Roe; H J Kaufman; N Williams
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The American surgeon     Volume:  67     ISSN:  0003-1348     ISO Abbreviation:  Am Surg     Publication Date:  2001 Nov 
Date Detail:
Created Date:  2001-12-03     Completed Date:  2001-12-14     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0370522     Medline TA:  Am Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1022-9     Citation Subset:  IM    
Department of Surgery, University of Tennessee College of Medicine, Chattanooga 37403, USA.
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MeSH Terms
Adenoma / complications,  radionuclide imaging*
Aged, 80 and over
Hyperparathyroidism / etiology
Intraoperative Care
Middle Aged
Parathyroid Hormone / blood
Parathyroid Neoplasms / complications,  radionuclide imaging*
Parathyroidectomy / methods*
Prospective Studies
Radiopharmaceuticals / diagnostic use*
Surgical Procedures, Minimally Invasive
Technetium Tc 99m Sestamibi / diagnostic use*
Treatment Outcome
Reg. No./Substance:
0/Parathyroid Hormone; 0/Radiopharmaceuticals; 109581-73-9/Technetium Tc 99m Sestamibi

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