Gamma Probe Guided Minimally Invasive Parathyroidectomy without Quick Parathyroid Hormone Measurement in the Cases of Solitary Parathyroid Adenomas

Abstract

Objective: In this study, our aim was to study the efficiency of gamma probe guided minimally invasive parathyroidectomy (GP-MIP), conducted without the intra-operative quick parathyroid hormone (QPTH) measurement in the cases of solitary parathyroid adenomas (SPA) detected with USG and dual phase 99mTc-MIBI parathyroid scintigraphy (PS) in the preoperative period.Material and Methods: This clinical study was performed in 31 SPA patients (27 female, 4 male; mean age 51±11years) between February 2006 and January 2009. All patients were operated within 30 days after the detection of the SPA with dual phase 99mTc-MIBI PS and USG. The GP-MIP was done 90-120 min after the iv injection of 740 MBq 99mTc-MIBI. In all cases, except 1 patient, the GP-MIP was performed under local anesthesia; due to the enormity of size of SPA, then general anesthesia is chosen.Results: The operation time was 30-60 min, mean 38,2±7 min. In the first postoperative day, there was a more than 50% decrease in PTH levels in all patients and all but one had normal serum calcium levels. Transient hypocalcemia was detected in one patient.Conclusion: GP-MIP without intra-operative QPTH measurement is a suitable method in the surgical treatment of SPA detected by dual phase 99mTc-MIBI PS and USG.Conflict of interest:None declared.

Location of Parathyroid Adenomas in Primary Hyperparathyroidism: Where to look?

“…10,11 Recent studies emphasized the utility of Tc-99m-MIBI scan in successful MIP with unilateral neck exploration. 12,13 High-quality scintigraphy with Tc-99m-MIBI can accurately localize parathyroid adenomas in 85 to 95% of patients with PHPT. 14-16 However, because close location of parathyroid glands to thyroid gland that is also metabolically active, results may not be satisfactory, particularly for intrathyroidal adenoma.…”

Adénome parathyroïdien cervical mimant un nodule isthmique de la thyroïde : intérêt de la TEMP/TDM dans la localisation des ectopies parathyroïdiennes. À propos d’un cas

“…Alors que la stratégie thérapeutique actuelle vise un repérage préopératoire des glandes parathyroïdes pathologiques, afin de réaliser un geste chirurgical ciblé permettant de s'affranchir d'une cervicotomie exploratrice, le développement de l'imagerie morpho-fonctionnelle a permis d'améliorer les performances de la chirurgie mini-invasive [6]. Ce repérage combine les données de l'échographie cervicale et de la SP au MIBITc 99m .…”