Radioguidance Is Not Necessary During Parathyroidectomy

Abstract

Background: Improvements in the accuracy of preoperative localization and the availability of the rapid parathyroid hormone assay have permitted minimally invasive parathyroidectomy in patients with primary hyperparathyoidism. Hypothesis: The use of intraoperative radioguidance is beneficial during targeted parathyroid operations. Design: A retrospective analysis of a prospective database of patients. Setting: Tertiary care referral center. Patients: During a 2 1 ⁄2-year period, 130 patients underwent minimally invasive, targeted parathyroidectomy with intraoperative monitoring of the parathyroid hormone level. Of these, 60 patients underwent radioguided parathyroidectomy. Prior to surgery, a solitary parathyroid adenoma was visualized on technetium Tc 99m sestamibi scintigraphy in all patients selected for radioguided parathyroidectomy. A gamma probe was used to guide the surgical dissection. Results: All patients were cured following radioguided parathyroidectomy. In 29 patients (48%), the probe provided confusing or inaccurate information; however, a unilateral neck exploration with excision of a parathyroid adenoma was successfully completed in each of these patients. Forty-three cases were completed under local anesthesia and 85% were discharged home on the same day of surgery. There was 1 temporary recurrent laryngeal nerve palsy. Conclusion: In the era of improved preoperative localization and intraoperative parathyroid hormone monitoring, the routine use of radioguidance is not recommended during parathyroidectomy.

Role of gamma probes in performing minimally invasive parathyroidectomy in patients with primary hyperparathyroidism: optimization of preoperative and intraoperative procedures

“…This discrepancy might be explained, at least in part, by considering the relatively lower sensitivity of the preoperative scintigraphy used by Bonjer et al (31) and Jaskowiak et al (27) (dual-phase technique) in comparison with our scintigraphic procedure (double-tracer technique): sensitivity for detection of parathyroid adenomas was 60 -74% vs 95% respectively. It appears surprising that such different and opposite opinions have been reported in the literature on the role of the gamma probe during parathyroidectomy, ranging from enthusiastic considerations (7,26,28), to less favorable results (16,27), to a judgment of uselessness (32). Some explanations can be made.…”

Kinetics of intraoperative fluorescence diagnosis of parathyroid glands

“…It decreased the duration of surgery and length of hospital stay, as well as alleviating the need to obtain frozen sections (16). However, radioguided parathyroidectomy remains controversial as several studies comparing preoperative imaging and intraoperative sestamibi scans did not recommend the routine use of radio-guidance during surgery (17,18). In unselected patients with primary HPT, preoperative sestamibi imaging was more accurate than intraoperative gamma probe detection in localizing abnormal PTGs (18).…”

Surgical strategy for sporadic primary hyperparathyroidism an evidence-based approach to surgical strategy, patient selection, surgical access, and reoperations

“…In addition, confusing or misleading information provided by the probe may unduly complicate the surgical procedure [54]. Finally, controversies persist on the best dose of MIBI, as well as on how to achieve the optimal time interval between injection and exploration [43].…”