Minimally invasive radioguided surgery for parathyroid adenomas (MIRP).
BACKGROUND
Parathyroid adenoma is the most common cause of primary hyperparathyroidism. Conventional surgical management includes bilateral neck exploration with removal of the adenoma(s) and biopsy of one of the other glands with visualization of all glands. It is associated with a risk of permanent hypoparathyroidism. Radioguided excision of parathyroid adenoma is a widely accepted technique which provides accurate localization and complete excision of the lesion with low morbidity. We report our experience with this technique.


METHODS
We performed radioguided excision of parathyroid adenomas in 15 patients. All of them had preoperative localization of the adenoma using a dual tracer, dual phase 99mTc-Sestamibi scan. A dose of 8-10 mCi of 99mTc-Sestamibi was injected intravenously 2 hours before surgery. Under local anaesthesia, surgical excision of the lesion was done after localizing it using a hand-held gamma probe. Complete excision was confirmed by frozen. section of the excised lesion and an intraoperative quick parathormone assay.


RESULTS
The 99mTc-Sestamibi scan revealed an increased uptake by the adenoma in all patients and complete excision was possible in all the patients. Frozen section confirmed the diagnosis and the quick parathormone assay (within 15 minutes) revealed a drop in parathormone levels to < 50% after excision in all of them. Three patients developed hypocalcaemia postoperatively and were treated with intravenous calcium supplementation. At a follow up of 2-29 months, all the patients were normocalcaemic. The renal functions improved in 2 of 6 patients who had renal failure.


CONCLUSIONS
Minimally invasive radioguided excision of parathyroid adenomas is a simple, safe and effective technique associated with a low morbidity and can be done as a day-care procedure.
Somashekhar
S P
SP
Manipal Hospital, Airport Road, Bangalore 600017, Karnataka, India. somusp@yahoo.com
Gupta
P
P
Ballal
S
S
Parameshwaran
Zaveri
S S
SS
Venkatachala
Udupa
K V
KV
D000328:Adult; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D011446:Prospective Studies; D011877:Radionuclide Imaging; D012307:Risk Factors; D017256:Technetium Tc 99m Sestamibi
D017256:Technetium Tc 99m Sestamibi