Intraoperative adjuncts in surgery for primary hyperparathyroidism.
OBJECTIVE
This paper is a review of the evidence base to produce recommendations for the use of intraoperative parathyroid hormone (PTH), radioguided parathyroidectomy (RGP), methylene blue (MB), frozen section, and intraoperative neuromonitoring during surgery for primary hyperparathyroidism (PHPT).


METHODS
A Medline keyword search of English-language articles led to the production of a draft document, subsequently revised by committee, containing levels of evidence and the grading of recommendations as proposed by the Agency for Healthcare Research and Quality.


RESULTS
Literature review provides the basis for clear recommendations on the use of intraoperative PTH at surgery for PHPT. There is little evidence to support the use of RGP, MB, routine frozen section, and intraoperative neuromonitoring.
Harrison
Barney J
BJ
Endocrine Surgery, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, UK. barney.harrison@sth.nhs.uk
Triponez
Frederic
F
D004396:Coloring Agents; D005629:Frozen Sections; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000097:blood / Q000000981:diagnostic imaging / Q000601:surgery*; D008751:Methylene Blue; D016343:Monitoring, Intraoperative; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012009:Recurrent Laryngeal Nerve / Q000502:physiology; D017256:Technetium Tc 99m Sestamibi
D004396:Coloring Agents; D010281:Parathyroid Hormone; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi; D008751:Methylene Blue