Controversies on minimally invasive procedures for radio-guided surgery of parathyroid tumours.
The definitive treatment of primary hyperparathyroidism (PHPT) is the surgical approach which traditionally consists of bilateral neck exploration with visualization of at least 4 parathyroid glands and removal of the enlarged ones. However, the most frequent cause of PHPT is a solitary parathyroid adenoma so that a limited neck exploration in order to remove the solitary adenoma alone appears adequate to many surgeons. The recent significant improvements achieved in the pre-operative parathyroid localization techniques, mainly the parathyroid scintigraphy, and the introduction in surgical practice of measurement of quick parathyroid hormone, endoscopic procedures, and intra-operative gamma probes used together specific radiopharmaceuticals allowed to offer the PHPT patient a limited neck exploration as the unilateral neck exploration and the minimally invasive parathyroidectomy. The present article deals with the role of the intra-operative gamma probes used together with specific radio-pharmaceuticals, discussing the principal advantages and disadvantages of each currently used radio-guided approach.
Rubello
D
D
Nuclear Medicine Unit, S. Maria della Misericordia Hospital, Rovigo Italy. domenico.rubello@libero.it
Pelizzo
M R
MR
Gross
M D
MD
Fig
L M
LM
Shapiro
B
B
Rampin
L
L
Mariani
G
G
D000236:Adenoma / Q000601:surgery; D005720:Gamma Rays; D006801:Humans; D006961:Hyperparathyroidism / Q000209:etiology / Q000601:surgery; D019060:Minimally Invasive Surgical Procedures; D010282:Parathyroid Neoplasms / Q000150:complications / Q000601:surgery*; D016105:Parathyroidectomy / Q000379:methods*; D019275:Radiopharmaceuticals
D019275:Radiopharmaceuticals