title: Minimally invasive radio-guided parathyroidectomy.
abstract: We reported here the data on minimally invasive radio-guided parathyroidectomy (MIRP) in a large group of 253 patients enrolled from the whole series of 355 consecutive patients affected by primary hyperparathyroidism (P-HPT) referred to our center. On the basis of preoperative imaging including Sestamibi scintigraphy and neck ultrasound (US), 263 patients (74% of the whole series) with evidence of a solitary parathyroid adenoma (PA) and a normal thyroid gland were addressed to MIRP and in 253 (96%) of them this minimally invasive neck exploration was successfully performed. The MIRP protocol developed in our center consisted of a very low 1 mCi Sestamibi injection in the operating room a few minutes before the start of intervention, thus minimizing the radiation exposure dose to the patient and personnel. No major intraoperative complication was recorded in patients treated by MIRP and only a transient hypocalcemia in 8.5% of cases. The mean duration time for MIRP was 35 min and the mean hospital stay 1.2 days. Local anesthesia was also performed in 62 patients, 54 of whom were elderly patients with concomitant invalidating diseases contraindicating general anesthesia. No HPT relapse was observed during subsequent follow-up. The gamma probe was used also during bilateral neck exploration in the group of 92 patients excluded from MIRP. The most frequent cause of exclusion from MIRP in our series was the presence of concomitant Sestamibi avid thyroid nodules (68.5% of cases) that can give false positive results at radio-guided surgery. In conclusion, MIRP is an effective treatment in patients with a high likelihood of a solitary PA and a normal thyroid gland at scintigraphy and US so that an accurate preoperative localizing imaging is required for MIRP. A low 1 mCi Sestamibi dose appears sufficient to perform MIRP. Patients with concomitant Sestamibi avid thyroid nodules should be excluded from MIRP.
authors.affiliation: Nuclear Medicine Service - PET Unit, "Santa-Maria-Della-Misericordia" Hospital, Istituto Oncologico Veneto (IOV), Viale Tre-Martiti, 140, 45100 Rovigo, Italy. rubello.domenico@azisanrovigo.it
authors.forename: Domenico
authors.initials: D
authors.lastname: Rubello
authors.forename: Sandro
authors.initials: S
authors.lastname: Giannini
authors.forename: Chiara
authors.initials: C
authors.lastname: Martini
authors.forename: Andrea
authors.initials: A
authors.lastname: Piotto
authors.forename: Lucia
authors.initials: L
authors.lastname: Rampin
authors.forename: Stefano
authors.initials: S
authors.lastname: Fanti
authors.forename: Michela
authors.initials: M
authors.lastname: Armigliato
authors.forename: Alfredo
authors.initials: A
authors.lastname: Nardi
authors.forename: Angelo
authors.initials: A
authors.lastname: Carpi
authors.forename: Giuliano
authors.initials: G
authors.lastname: Mariani
authors.forename: Milton D
authors.initials: MD
authors.lastname: Gross
authors.forename: Maria Rosa
authors.initials: MR
authors.lastname: Pelizzo
mesh_terms: D000236:Adenoma / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D015902:Gamma Cameras; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010282:Parathyroid Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D016105:Parathyroidectomy / Q000379:methods; D018579:Patient Selection; D015642:Radiology, Interventional / Q000295:instrumentation*; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi; D016896:Treatment Outcome
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi