1112 Consecutive Bilateral Neck Explorations for Primary Hyperparathyroidism

Allendorf, John; DiGorgi, Mary; Spanknebel, Kathryn; Inabnet, William B.; Chabot, John A.; LoGerfo, Paul

doi:10.1007/s00268-007-9068-5

Cited by 109 publications

(58 citation statements)

References 20 publications

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“…Due to the complexity of mediastinal parathyroid disease, it becomes more important to utilize a combination of both structural (US, CT) and functional (MIBI) localization studies in order to confidently identify the diseased gland prior to embarking on a mediastinal exploration. [3][4][5][6] The potential morbidity related to a thoracic exploration can be significant, and as our small case series demonstrates, intraoperative identification of these ectopic glands can be very challenging even in the setting of clear localizing studies. Consequently, clear confirmation of the mediastinal gland location by a minimum of two localizing studies, including at least one functional study, is recommended.…”

Section: Discussionmentioning

confidence: 99%

Thoracic Exploration for Mediastinal Parathyroids requires a Multidisciplinary Approach

Mitchell

Milas

Berber

et al. 2012

World Journal of Endocrine Surgery

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Mediastinal parathyroid disease requiring a thoracic surgical approach is a rare and challenging clinical entity. The objective of this study was to review our experience treating these patients, highlighting the importance of a multidisciplinary approach. Seven patients required a thoracic approach for mediastinal parathyroid disease between 1999 and 2010. All patients achieved biochemical cure with varying combinations of preoperative and intraoperative localizing studies interpreted by a multidisciplinary team, including radiologists, thoracic and endocrine surgeons, being required in each patient.

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Section: Discussionmentioning

confidence: 99%

Thoracic Exploration for Mediastinal Parathyroids requires a Multidisciplinary Approach

Mitchell

Milas

Berber

et al. 2012

World Journal of Endocrine Surgery

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“…[21] It remains the standard procedure for patients with multigland hyperplasia, multiple endocrine neoplasia, parathyroid cancer or failure of preoperative localization. [9] Because MIP can underestimate in patients with multigland disease, it might increase the risk of persistent or recurrent hypercalcemia.…”

Section: Discussionmentioning

confidence: 99%

Parathyroid scintigraphy and minimal invasive surgery in parathyroid adenomas

Özkul

Uyar²,

Bayram³

et al. 2015

Kulak Burun Bogaz Ihtis Derg

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Objectives: This study aims to identify the diagnostic capacity of the technetium 99m sestamibi scintigraphy with single photon emission computed tomography for localizing parathyroid pathologies.Patients and Methods: Data of 13 patients (4 males, 9 females; mean age 49.23 years; range 27 to 63 years) who had minimally invasive parathyroidectomy due to primary hyperparathyroidism at the Haseki Training and Research Hospital Ear-Nose-Throat clinic between January 2013 and December 2013 were retrospectively analyzed. Two patients were excluded due to incomplete documentation. Results:Mean preoperative parathyroid hormone and calcium levels were 284.36 (134-1,083 pg/mL) and 11.9 (10.7-13.5 mg/dL), respectively. The operation was deemed adequate if intraoperative parathyroid hormone dropped by 50% from the preoperative level or frozen section analysis showed hypercellular gland or adenoma. Only sestamibi scintigraphy results were consistent with focal exploration findings in all patients. Focal exploration and parathyroid adenoma excision via minimally invasive parathyroidectomy were successfully carried out in 10 patients with single adenoma confirmed by sestamibi. Conclusion:Technetium 99m sestamibi scintigraphy with single photon emission computed tomography and frozen section analysis may provide more meaningful information and be more advantageous compared to other preoperative localization techniques.Keywords: Parathyroidectomy; primary hyperparathyroidism; technetium 99m sestamibi. ÖZAmaç: Bu çalışmada, paratiroid patolojileri lokalize etmede tek foton emisyon bilgisayarlı tomografi ile teknesyum 99m sestamibi sintigrafinin diyagnostik kapasitesi tanımlandı. Hastalar ve Yöntemler:Ocak 2013-Aralık 2013 tarihleri arasında Haseki Eğitim ve Araştırma Hastanesi Kulak-Burun-Boğaz Kliniğinde primer hiperparatiroidizm nedeniyle minimal invaziv paratiroidektomi yapılan 13 hastanın (4 erkek, 9 kadın; ort. yaş 49.23 yıl; dağılım 27-63 yıl) verileri retrospektif olarak incelendi. İki hasta eksik belge nedeniyle çalışma dışı bırakıldı. Bulgular:Ameliyat öncesi ortalama paratiroid hormonu ve kalsiyum seviyeleri sırasıyla 284.36 (134-1083 pg/mL) ve 11.9 (10.7-13.5 mg/dL) idi. Ameliyat sırası paratiroid hormonunun ameliyat öncesi seviyenin %50 altına düşmesi veya dondurulmuş kesit incelemesinin hiperselüler bez veya adenoma göstermesi halinde ameliyat yeterli kabul edildi. Tüm hastalarda, sadece sestamibi sintigrafi sonuçları ile fokal eksplorasyon sonuçları uyumluydu. Sestamibi ile tek adenoma tespit edilen 10 hastada minimal invaziv paratiroidektomi yoluyla fokal eksplorasyon ve paratiroid adenoma eksizyonu başarıyla yapıldı. Sonuç:Tek foton emisyon bilgisayarlı tomografi ile teknesyum 99m sestamibi sintigrafi ve dondurulmuş kesit analizi diğer ameliyat öncesi lokalizasyon tekniklerine göre daha anlamlı bilgiler sağlayıp daha avantajlı olabilir.Anahtar Sözcükler: Paratiroidektomi; primer hiperparatiroidizm; teknesyum 99m sestamibi.

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“…Bilateral neck exploration with the objective of visualizing all of the parathyroid glands used to be the standard surgical procedure for pHPT with excellent outcomes of more than 95% cure rate [1][2][3][4]. Recently, preoperative localization imaging studies including by sestamibi scintigraphy and ultrasonography, have enabled accurate localization of enlarged parathyroid glands [5][6][7], and the surgical approach to the treatment of pHPT has changed to image-guided, focused, targeted parathyroidectomy through smaller incisions, with fewer complications and a shorter operating time [8][9][10][11].…”

Section: Discussionmentioning

confidence: 99%

“…

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mentioning

confidence: 99%

Minimally invasive surgery for primary hyperparathyroidism with or without intraoperative parathyroid hormone monitoring

et al. 2010

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Bilateral neck exploration, the identification of all parathyroid glands and removal of all abnormal glands, has traditionally been regarded as the standard surgical strategy for the treatment of primary hyperparathyroidism (pHPT) [1][2][3][4]. However, in recent years, several investigators have questioned the routine performance of bilateral neck exploration because the cause of pHPT in most patients is a single parathyroid adenoma and preoperative imaging tests, such as Technetium-99m sestamibi scans and ultrasound examination have enabled precise localization of the affected parathyroid gland with high sensitivity [5][6][7]. Use of intraoperative PTH (IOPTH) measurement or the gamma probe with perioperative sestamibi injection has also contributed to improving results A group who underwent surgery without IOPTH monitoring (Group 1; n=87), and a group who underwent surgery with IOPTH monitoring (Group 2; n=80), in which IOPTH was measured at 5, 10, 15 minutes after excision of the abnormal parathyroid gland. Criterion for evaluation as a cure was a drop in intact PTH level of 50% or more from the preoperative baseline value. The overall cure rate in Group 1 was 93.1%. An enlarged parathyroid gland that was consistent with the results of a preoperative imaging study was found in 84 patients (96.6%). The overall cure rate in Group 2 was 97.5%. In 7 of the patients, there was no drop of 50% or more at any of the 3 points in time measured. Two of these patients were found to have had double adenomas, one on each side, during the initial surgery. Three others were eucalcemic and had normal intact PTH values after surgery, and the remaining 2 patients had persistent disease. Although preoperative localization studies are accurate and essential, IOPTH monitoring improves the cure rate of minimally invasive parathyroidectomy. IOPTH monitoring is a valuable adjunct to achieve adequate intraoperative decision-making, recognizing and resecting additional image-negative hyperfunctioning lesions.

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1112 Consecutive Bilateral Neck Explorations for Primary Hyperparathyroidism

Cited by 109 publications

References 20 publications

Thoracic Exploration for Mediastinal Parathyroids requires a Multidisciplinary Approach

Thoracic Exploration for Mediastinal Parathyroids requires a Multidisciplinary Approach

Parathyroid scintigraphy and minimal invasive surgery in parathyroid adenomas

Minimally invasive surgery for primary hyperparathyroidism with or without intraoperative parathyroid hormone monitoring

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