Minimally invasive surgery for treatment of hyperparathyroidism.
BACKGROUND
Minimal invasive surgery for parathyroidectomy has been introduced in the treatment of hyperparathyroidism.


OBJECTIVE
To evaluate the contribution of the sestamibi-SPECT (MIBI) localization, cervical ultrasonography, and intraoperative rapid turbo intact parathormone assay in minimal invasive parathyroidectomy.


METHODS
Between August 1999 and March 2004, 146 consecutive hyperthyroid patients were treated using the MIBI and ultrasound for preoperative localization and iPTH measurements for intraoperative assessment.


RESULTS
Parathyroid adenoma was detected in 106 patients, primary hyperplasia in 16, secondary hyperplasia in 16, tertiary hyperplasia in 5, and parathyroid carcinoma in 1 patient. Minimal invasive exploration of the neck was performed in 84 of the 106 patients (79.2%) with an adenoma, and in 17 of them this procedure was performed under local cervical block anesthesia in awake patients. Adenoma was correctly diagnosed by MIBI scan in 74% of the patients, and by ultrasound in 61%. The addition of ultrasonography to MIBI increased the accuracy of adenoma detection to 83%. In 2 of the 146 patients (1.4%) iPTH could not be significantly reduced during the initial surgical procedure. Minimal invasive surgery with minimal morbidity, and avoiding bilateral neck exploration, was achieved in 79.2% of patients with a primary solitary adenoma.


CONCLUSIONS
Preoperative localizationof the parathyroid gland by MIBI and ultrasound together with intraoperative iPTH measurements resulted in an overall cure rate of 98.6% for the entire series, The addition of ultrasound to the MIBI scan increased the accuracy of adenoma detection.
Mekel
Michal
M
Department of Surgery A, Rambam Medical Center, Haifa, Israel.
Mahajna
Ahmed
A
Ish-Shalom
Sofia
S
Barak
Michal
M
Segal
Elena
E
Salih
Adel Abu
AA
Bishara
Bishara
B
Shen-Or
Zila
Z
Krausz
Michael M
MM
D000236:Adenoma / Q000150:complications / Q000175:diagnosis*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002118:Calcium / Q000097:blood; D002277:Carcinoma / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D006965:Hyperplasia / Q000150:complications / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D016343:Monitoring, Intraoperative / Q000379:methods; D010280:Parathyroid Glands / Q000000981:diagnostic imaging / Q000473:pathology; D010281:Parathyroid Hormone / Q000097:blood; D010282:Parathyroid Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D016105:Parathyroidectomy / Q000379:methods*; D011446:Prospective Studies; D011859:Radiography; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods; D014463:Ultrasonography
D010281:Parathyroid Hormone; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi; D002118:Calcium