title: Role of gamma probes in performing minimally invasive parathyroidectomy in patients with primary hyperparathyroidism: optimization of preoperative and intraoperative procedures.
abstract: OBJECTIVE
  In the last decade, surgery of primary hyperparathyroidism (HPT) due to a solitary adenoma has moved on from the traditional wide bilateral neck exploration (BNE) to more limited approaches such as unilateral neck exploration and minimally invasive parathyroidectomy.
  
  
  METHODS
  To define the role of intraoperative gamma probe and injection of a low (99m)Tc-MIBI dose in performing minimally invasive radio-guided surgery (MIRS) in HPT patients with a solitary parathyroid adenoma.
  
  
  METHODS
  From September 1999 to July 2002, 214 patients with primary HPT entered the study. All patients were preoperatively investigated by a (99m)Tc-pertechnetate/MIBI subtraction scan and high-resolution neck ultrasound. The intraoperative technique we developed differs from other previously described techniques being based on the injection of a low (37 MBq) MIBI dose in the operating theatre a few minutes before the beginning of intervention.
  
  
  RESULTS
  On the basis of scan/ultrasound findings 147 patients were selected for a MIRS and 144 of them (98%) were successfully treated by this approach: a solitary parathyroid adenoma was removed through a small 2-2.5 cm skin incision with a mean operative time of 35 min, and a mean hospital stay of 1.2 days. In the other 67 patients with scan/ultrasound evidence of concomitant nodular goiter (n=45) or multi-gland disease (n=13) or with a negative scan (n=9), the gamma probe was utilized during a traditional BNE. A low 37 MBq MIBI dose proved to be sufficient to perform a MIRS; moreover it delivered to the patient and surgeon a low, negligible, radiation exposure dose.
  
  
  CONCLUSIONS
  The combination of a (99m)Tc-pertechnetate/MIBI subtraction scan and neck ultrasound appears to be an accurate imaging protocol in selecting primary HPT patients as candidates for a MIRS. A MIBI dose as low as 37 MBq injected in the operating theatre just before the start of surgery appears to be adequate to perform radio-guided surgery.
authors.affiliation: Nuclear Medicine Service, Department of Radiotherapy, Regional Hospital of Padua, Padua, Italy. domenico.rubello@sanita.padova.it
authors.forename: Domenico
authors.initials: D
authors.lastname: Rubello
authors.forename: Andrea
authors.initials: A
authors.lastname: Piotto
authors.forename: Dario
authors.initials: D
authors.lastname: Casara
authors.forename: Pier Carlo
authors.initials: PC
authors.lastname: Muzzio
authors.forename: Brahm
authors.initials: B
authors.lastname: Shapiro
authors.forename: Maria Rosa
authors.initials: MR
authors.lastname: Pelizzo
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging* / Q000601:surgery*; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D016105:Parathyroidectomy / Q000379:methods*; D011300:Preoperative Care; D011877:Radionuclide Imaging; D013670:Sodium Pertechnetate Tc 99m; D017256:Technetium Tc 99m Sestamibi
chemical_list: D017256:Technetium Tc 99m Sestamibi; D013670:Sodium Pertechnetate Tc 99m