Minimal-access parathyroid surgery using intraoperative parathyroid hormone assay.
OBJECTIVE
Review the most current preoperative localization imaging techniques in patients with primary hyperparathyroidism and demonstrate their applicability to targeted tumor removal with intraoperative parathyroid hormone (PTH) monitoring.


METHODS
Retrospective review of 40 consecutive patients undergoing parathyroid surgery with intraoperative PTH assay as the principal determinant of correction of the hyperparathyroid state. Details of the technology, cost analysis, and comparison with other management methods are discussed.


METHODS
The standard intact PTH chemiluminescent assay (Nichols Diagnostics) and modifications to allow accelerated intraoperative results are discussed in detail. The time intervals between completion of parathyroid excision and postremoval assay and subsequent laboratory investigation present a practical therapeutic algorithm.


RESULTS
Forty consecutive patients with hyperparathyroidism were treated surgically with intraoperative PTH as the determinant of satisfactory resolution of the disease state. In most instances, the surgical field was reduced to the targeted pathology identified by preoperative localization, and all patients became eucalcemic when this method was employed. Approximately half of eligible patients were treated under local anesthesia.


CONCLUSIONS
Intraoperative PTH assay has added a new dimension to primary and revision parathyroid surgery. It is cost-effective and accurate and may reduce the morbidity of surgical intervention in revision procedures.
Division of Otolaryngology-Head and Neck Surgery, The University of Vermont School of Medicine, USA.
R A
RA
Sofferman
J
J
Standage
M E
ME
Tang
D000236:Adenoma / Q000097:blood / Q000000981:diagnostic imaging / Q000601:surgery*; D000465:Algorithms; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000601:surgery*; D015592:Immunoradiometric Assay / Q000379:methods; D008163:Luminescent Measurements; D016343:Monitoring, Intraoperative; D010281:Parathyroid Hormone / Q000097:blood*; D010282:Parathyroid Neoplasms / Q000097:blood / Q000000981:diagnostic imaging / Q000601:surgery*; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000097:blood / Q000601:surgery; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D017256:Technetium Tc 99m Sestamibi
D010281:Parathyroid Hormone; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi