title: Surgeon performed ultrasound facilitates minimally invasive parathyroidectomy by the focused lateral mini-incision approach.
abstract: BACKGROUND
  Minimally invasive parathyroidectomy (MIP) is now widely accepted where a single adenoma can be localized preoperatively. In our unit, MIP is offered once a parathyroid adenoma is localized with a sestamibi (MIBI) scan, with or without a concordant neck ultrasound. The aim of this study was to compare the accuracy of surgeon performed ultrasound (SUS) with radiologist performed ultrasound (RUS) in the localization of a parathyroid adenoma in MIBI-positive primary hyperparathyroidism (PHPT).
  
  
  METHODS
  This is a prospective study of patients undergoing parathyroidectomy for sporadic primary hyperparathyroidism (PHPT) from April 2005 to October 2006 at the University of Sydney Endocrine Surgical Unit. Patients were then divided into those who underwent preoperative RUS or SUS.
  
  
  RESULTS
  Two-hundred eighteen patients formed the study group. One hundred forty-eight (66%) patients had RUS and 87 (39%) had SUS. Overall, RUS correctly localized the parathyroid adenomas in 121 of 148 (82%) patients. Surgeon performed ultrasound correctly localized the abnormal parathyroid adenoma in 72 of 87 (83%) of cases. There was no significant difference in the proportion of patients with single gland disease, double adenomas, or hyperplasia correctly localized by SUS or RUS. Incorrect interpretation of ultrasound imaging was due to cystic degeneration in thyroid nodules, lymph nodes, retro-esophageal location of adenomas and ectopic and small parathyroid glands.
  
  
  CONCLUSIONS
  Surgeon performed ultrasound is a useful adjunctive tool to MIBI localization for facilitating MIP and when performed by experienced parathyroid surgeons, it can achieve accuracy rates equivalent to that of a dedicated parathyroid radiologist.
authors.affiliation: University of Sydney Endocrine Surgical Unit, Royal North Shore Hospital, St. Leonards, NSW 2065, Australia. patsysoon@med.usyd.edu.au
authors.forename: Patsy S H
authors.initials: PS
authors.lastname: Soon
authors.forename: Leigh W
authors.initials: LW
authors.lastname: Delbridge
authors.forename: Mark S
authors.initials: MS
authors.lastname: Sywak
authors.forename: Beverley M
authors.initials: BM
authors.lastname: Barraclough
authors.forename: Pam
authors.initials: P
authors.lastname: Edhouse
authors.forename: Stan B
authors.initials: SB
authors.lastname: Sidhu
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D002983:Clinical Competence; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D016105:Parathyroidectomy / Q000379:methods*; D018579:Patient Selection; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D014463:Ultrasonography / Q000379:methods