Radioguided parathyroidectomy for primary hyperparathyroidism using the solid-state, multi-crystal gamma camera.
BACKGROUND
Minimally invasive radioguided parathyroidectomy (MIRP) offers several cosmetic and surgical advantages. Intraoperative 99m-Tc sestamibi scintigraphy using a solid-state, multi-crystal gamma camera was used to perform the MIRP. We report a case of primary hyperparathyroidism treated with this surgical procedure and discuss the usefulness of intraoperative scintigraphy.


METHODS
The patient was a 58-year-old Japanese woman was given a diagnosis of primary hyperparathyroidism. One hour before the operation, 99m-Tc sestamibi was injected intravenously and scintigraphy was performed in the operating room before the skin incision. Sestamibi imaging revealed an abnormal uptake close to the lower right lobe of the thyroid gland and MIRP was performed. After the tumor behind the right recurrent laryngeal nerve close to the lower right lobe of the thyroid gland was removed, intraoperative scintigraphy still revealed an abnormal uptake. MIRP was continued and an abnormal parathyroid gland behind the right carotid artery near the right recurrent laryngeal nerve was identified. After removing a parathyroid adenoma from this second location, intraoperative sestamibi imaging revealed no abnormal uptake.


RESULTS
The operation time was 80 minutes and the amount of bleeding was 12 ml. Postoperatively, serum calcium and PTH levels were within normal range. No complications were observed.


CONCLUSIONS
Intraoperative sestamibi imaging using a portable gamma camera is useful for locating abnormal parathyroid glands.
Kitagawa
Wataru
W
Division of Endocrine Surgery, Department of Surgery II, Nippon Medical School, Tokyo, Japan. w-kita@nms.ac.jp
Shimizu
Kazuo
K
Akasu
Haruki
H
D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging / Q000601:surgery*; D007564:Japan; D008875:Middle Aged; D016105:Parathyroidectomy / Q000379:methods; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D016634:Radiosurgery; D017256:Technetium Tc 99m Sestamibi
D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi