title: Minimally invasive parathyroidectomy as treatment for primary hyperparathyroidism.
abstract: BACKGROUND
  Current techniques for management of primary hyperpara-thyroidism (pHPT) rely on preoperative localization studies in order to perform a direct exploration of the neck. This case series reports the results of minimally invasive parathyroidectomy (MIP) performed in twenty-two consecutive pHPT patients with suspected parathyroid adenoma.
  
  
  METHODS
  All patients with symptomatic pHPT and or aberrant biochemical markers underwent preoperative evaluation including calcium and parathyroid hormone (PTH) serum levels, and a Tc-99 Sestamibi (MIBI) scintigraphy scan. The day of surgery Tc-99 MIBI was administered intravenously to localize diseased parathyroid glands. Within the next two hours after administration of IV contrast a gamma radiation detection device was applied over the neck to detect areas of prominent radiation gradient that served as landmarks during surgery. All removed tissue was again tested with the gamma radiation probe and sent for frozen sections to confirm parathyroid gland tissue. Serum calcium levels were measured immediately after surgery, 24 hours, and 3 days later at an outpatient visit.
  
  
  RESULTS
  Twenty-two patients with symptomatic hypercalcemia (6 M, 16 F), mean age of 63 years (Range 35 to 87), completed pre-operative Sestamibi scintigraphy and follow up evaluations. Mean pre-operative calcium and PTH levels were 11.3 mg/dL and 194.2 pg/mL, respectively. Preoperative Sestamibi scintigraphy were negative in four (18%) and positive in 18 (82%) patients. Parathyroid adenoma was confirmed by frozen sections in all patients. The mean operative time was approximately 32 minutes except in 3 cases which required combined surgical procedures. There were no intra-operative complications while minor wound swelling was the only postoperative complication reported. All patients exhibited decreased serum calcium levels with resolution of symptoms within a week, and resumed a normal lifestyle.
  
  
  CONCLUSIONS
  MIP using preoperative Tc-99 MIBI scan is an excellent and safe treatment for patients in pHPT patients with a suspected parathyroid adenoma. In our experience this technique avoids the potential complications of extensive neck exploration, reduces operative time, and has a high patient acceptance.
authors.affiliation: Department of Otolaryngology & Head and Neck Surgery, University of Puerto Rico School of Medicine, Rio Piedras, Puerto Rico. laureano_giraldez@hotmail.com
authors.forename: Laureano A
authors.initials: LA
authors.lastname: Giraldez-Rodriguez
authors.forename: Laureano J
authors.initials: LJ
authors.lastname: Giraldez-Casasnovas