title: Potential role of a new hand-held miniature gamma camera in performing minimally invasive parathyroidectomy.
abstract: OBJECTIVE
  Sestamibi scans have increased the use of minimally invasive parathyroidectomy (MIP) to treat primary hyperparathyroidism (PHPT) when caused by a parathyroid single adenoma. The greatest concern for surgeons remains the proper identification of pathological glands in a limited surgical field. We have studied the usefulness of a new hand-held miniature gamma camera (MGC) when used intraoperatively to locate parathyroid adenomas. To our knowledge this is the first report published on this subject in the scientific literature.
  
  
  METHODS
  Five patients with PHPT secondary to a single adenoma, positively diagnosed by preoperative sestamibi scans, underwent a MIP. A gamma probe for radioguided surgery and the new hand-held MGC were used consecutively to locate the pathological glands. This new MGC has a module composed of a high-resolution interchangeable collimator and a CsI(Na) scintillating crystal. It has dimensions of around 15 cmx8 cmx9 cm and weighs 1 kg. The intraoperative assay of PTH (ioPTH) was used to confirm the complete resection of pathological tissue.
  
  
  RESULTS
  All cases were operated on successfully by a MIP. The ioPTH confirmed the excision of all pathological tissues. The MGC proved its usefulness in all patients, even in a difficult case in which the first attempt with the gamma probe failed. In all cases it offered real-time accurate intraoperative images.
  
  
  CONCLUSIONS
  The hand-held MGC is a useful instrument in MIP for PHPT. It may be used to complement the standard tools used to date, or may even replace them, at least in selected cases of single adenomas.
authors.affiliation: Department of Surgery, University of Valencia, Clinic University Hospital, Av. Blasco Ibanez 17, 46010 Valencia, Spain. joaquin.ortega@uv.es
authors.forename: Joaquin
authors.initials: J
authors.lastname: Ortega
authors.forename: Jose
authors.initials: J
authors.lastname: Ferrer-Rebolleda
authors.forename: Norberto
authors.initials: N
authors.lastname: Cassinello
authors.forename: Salvador
authors.initials: S
authors.lastname: Lledo
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging* / Q000601:surgery*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005240:Feasibility Studies; D015902:Gamma Cameras / Q000639:trends*; D006801:Humans; D008904:Miniaturization; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D016105:Parathyroidectomy / Q000295:instrumentation* / Q000379:methods; D011877:Radionuclide Imaging; D025321:Surgery, Computer-Assisted / Q000295:instrumentation* / Q000379:methods; D016896:Treatment Outcome