title: Minimally invasive radio-guided parathyroidectomy in 152 consecutive patients with primary hyperparathyroidism.
abstract: OBJECTIVE
  To examine the results of minimally invasive radio-guided parathyroidectomy (MIRP) in the treatment of patients with primary hyperparathyroidism, including factors associated with negative technetium-labeled sestamibi scanning.
  
  
  METHODS
  We retrospectively analyzed the findings in a group of 152 consecutive patients encountered during the period 2001 through 2004. The overall accuracy of preoperative sestamibi scanning was assessed, and the success of MIRP was determined on the basis of operative time, duration of hospital stay, and rate of complications.
  
  
  RESULTS
  All 152 patients underwent preoperative sestamibi scanning; 118 (78%) had positive scans and were treated with MIRP, whereas 34 (22%) had negative scans and underwent traditional neck explorations. Patients with negative sestamibi scans had 5 times the incidence of concomitant thyroid disease in comparison with those who had positive sestamibi scans (P<0.01), and they had higher rates of parathyroid hyperplasia (26% versus 0%; P<0.01). In comparison with traditional neck dissection, MIRP-treated patients had shorter operative times (38 minutes versus 86 minutes; P<0.01) and shorter hospital stays (0.67 day versus 1.09 days; P<0.01). Among the MIRP-treated patients, 67% were discharged the same day as performance of the outpatient surgical procedure. Correction of hypercalcemia was accomplished in 116 of 118 patients (98%) who underwent MIRP. Complications in the MIRP group were low, including 1 postoperative hemorrhage. No cases of recurrent laryngeal nerve injury occurred. There were 2 false-positive sestamibi scans (1.3%).
  
  
  CONCLUSIONS
  Parathyroid hyperplasia and concomitant thyroid pathologic conditions are associated with negative preoperative sestamibi scans. MIRP is applicable in 78% of patients with primary hyperparathyroidism and is a safe, effective operation that results in shorter surgical time, reduced hospital stay, and minimal complications.
authors.affiliation: From the Austin Surgeons, PLLC, Seton Medical Center, Austin, Texas 78746, USA.
authors.forename: Douglas
authors.initials: D
authors.lastname: Politz
authors.forename: Charles D
authors.initials: CD
authors.lastname: Livingston
authors.forename: Brant
authors.initials: B
authors.lastname: Victor
authors.forename: Robert
authors.initials: R
authors.lastname: Askew
authors.forename: Lamar
authors.initials: L
authors.lastname: Jones
mesh_terms: D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D016105:Parathyroidectomy / Q000379:methods*; D011300:Preoperative Care; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted; D017256:Technetium Tc 99m Sestamibi; D013997:Time Factors; D014055:Tomography, Emission-Computed / Q000379:methods
chemical_list: D017256:Technetium Tc 99m Sestamibi