Real-Time Super Selective Venous Sampling in Remedial Parathyroid Surgery

Lebastchi, Amir H.; Aruny, John E.; Donovan, Patricia; Gibson, Courtney; Callender, Glenda G.; Carling, Tobias; Udelsman, Robert

doi:10.1016/j.jamcollsurg.2015.01.004

Cited by 37 publications

(27 citation statements)

References 17 publications

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“…Venous sampling may consist simply of a single sample taken from each internal jugular vein under ultrasound guidance to lateralize disease to one side of the neck or 20 to 30 samples obtained from numerous vessels draining the neck and upper thorax via a femoral venous approach under fluoroscopic guidance. The latter more invasive procedure should only be considered when other cross‐sectional imaging studies and scintigraphy are unhelpful . Combining venous sampling with selective parathyroid arteriography has been shown to improve localization when compared to venous sampling alone .…”

Section: Section 1: Preoperative Evaluationmentioning

confidence: 99%

“…The latter more invasive procedure should only be considered when other cross-sectional imaging studies and scintigraphy are unhelpful. [47][48][49][50] Combining venous sampling with selective parathyroid arteriography has been shown to improve localization when compared to venous sampling alone. 50 Its major advantages are the ability to identify parathyroid glands that cannot be otherwise visualized and to demonstrate venous drainage from neck and upper thoracic vessels that may have been disturbed as a consequence of previous central neck surgery.…”

Section: Parathyroid Venous Sampling and Parathyroid Angiographymentioning

confidence: 99%

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AHNS Series: Do you know your guidelines? Optimizing outcomes in reoperative parathyroid surgery: Definitive multidisciplinary joint consensus guidelines of the American Head and Neck Society and the British Association of Endocrine and Thyroid Surgeons

et al. 2018

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Background Revision parathyroid is challenging due to possible diagnostic uncertainty as well as the technical challenges it can present. Methods A multidisciplinary panel of distinguished experts from the American Head and Neck Society (AHNS) Endocrine Section, the British Association of Endocrine and Thyroid Surgeons (BAETS), and other invited experts have reviewed this topic with the purpose of making recommendations based on current best evidence. The literature was also reviewed on May 12, 2017. PubMed (1946‐2017), Cochrane SR (2005‐2017), CT databases (1997‐2017), and Web of Science (1945‐2017) were searched with the following strategy: revision and reoperative parathyroidectomy to ensure completeness. Results Guideline recommendations were made in 3 domains: preoperative evaluation, surgical management, and alternatives to surgery. Eleven guideline recommendations are proposed. Conclusion Reoperative parathyroid surgery is best avoided if possible. Our literature search and subsequent recommendations found that these cases are best managed by experienced surgeons using precision preoperative localization, intraoperative parathyroid hormone (PTH), and the team approach.

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Section: Section 1: Preoperative Evaluationmentioning

confidence: 99%

Section: Parathyroid Venous Sampling and Parathyroid Angiographymentioning

confidence: 99%

AHNS Series: Do you know your guidelines? Optimizing outcomes in reoperative parathyroid surgery: Definitive multidisciplinary joint consensus guidelines of the American Head and Neck Society and the British Association of Endocrine and Thyroid Surgeons

et al. 2018

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“…[100][101][102] Alternatively, safer and less timeconsuming non-SVS has also been used to detect a localizing parathyroid gradient augmented through employing a systemic hypocalcemic challenge. 103 Similarly, using rapid assay for measuring PTH in US-guided fine needle aspirate from a suspicious parathyroid lesion has also been reported to be an efficient method of localization.…”

Section: In the Radiology Suitementioning

confidence: 99%

Quick parathyroid hormone assays: a comprehensive review of their utility in clinical practice

Shawky

2016

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Continuous development of quick parathyroid hormone assays has resulted in a corresponding expansion of their applications in the practical landscape. In-theatre measurement of the parathyroid hormone has long been recognized as a valuable adjunct in parathyroid surgery, with other applications being incorporated in thyroid surgery and out-of-theatre uses. Such widespread utilization of these assays has also brought the concept of point-of-care testing to the endocrine surgical patient. We have herein summarized the established and potential applications of these assays, emphasizing their importance in the point-of-care setting, highlighting the proper selection of the assay type for intraoperative hormone monitoring and spotlighting those applications which should be validated for use in the clinical setting and those which need to be investigated further.

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“…When ultrasonography, MIBI/SPECT–CT and 4DCT findings are inconclusive, interventional radiology techniques such as selective venous sampling, ideally with angiography, may be considered. Recently, [ 18 F]fluorocholine PET–CT has been found to identify pathological parathyroid glands.…”

Section: Introductionmentioning

confidence: 99%

Video‐assisted thoracoscopic surgery for ectopic mediastinal parathyroid adenoma

et al. 2019

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BackgroundPrimary hyperparathyroidism (PHPT), caused by an ectopic mediastinal parathyroid adenoma, is uncommon. In the past, when the adenoma was not accessible from the neck, median sternotomy was advocated for safe and successful parathyroidectomy. Video‐assisted thoracoscopic surgical (VATS) parathyroidectomy represents a modern alternative approach to this problem.MethodsInformation on patients undergoing VATS was obtained from a specific database, including clinical presentation, biochemistry, preoperative imaging, surgical approach and patient outcomes. A comprehensive literature review was undertaken to draw comparisons with other publications.ResultsOver a 2‐year period, nine patients underwent VATS parathyroidectomy for sporadic PHPT. Five patients had persistent PHPT following previous unsuccessful parathyroidectomy via cervicotomy, and four had had no previous parathyroid surgery. The median duration of surgery was 90 (range 60–160) min. Eight patients were cured biochemically, with no major complications. One patient required conversion to a median sternotomy for removal of a thymoma that had resulted in false‐positive preoperative imaging.ConclusionWith appropriate preoperative imaging, multidisciplinary input and expertise, VATS parathyroidectomy is an effective, safe and well tolerated approach to ectopic mediastinal parathyroid adenoma.

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Real-Time Super Selective Venous Sampling in Remedial Parathyroid Surgery

Cited by 37 publications

References 17 publications

AHNS Series: Do you know your guidelines? Optimizing outcomes in reoperative parathyroid surgery: Definitive multidisciplinary joint consensus guidelines of the American Head and Neck Society and the British Association of Endocrine and Thyroid Surgeons

AHNS Series: Do you know your guidelines? Optimizing outcomes in reoperative parathyroid surgery: Definitive multidisciplinary joint consensus guidelines of the American Head and Neck Society and the British Association of Endocrine and Thyroid Surgeons

Quick parathyroid hormone assays: a comprehensive review of their utility in clinical practice

Video‐assisted thoracoscopic surgery for ectopic mediastinal parathyroid adenoma

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