title: Minimally invasive parathyroidectomy: use of intraoperative parathyroid hormone assays after 2 preoperative localization studies.
abstract: OBJECTIVE
  To review minimally invasive parathyroidectomy (MIP) in patients undergoing initial surgical management of primary hyperparathyroidism (HPT) with preoperative, localizing sestamibi scanning (MIBI), and concordant ultrasonography (US) to determine if intraoperative parathyroid hormone (iPTH) is necessary in these cases. Minimally invasive parathyroidectomy has become an acceptable therapeutic option in treating primary HPT. Preoperative MIBI scanning, high-resolution US with color Doppler flow, and iPTH monitoring have refined this technique.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  The medical records of 738 consecutive patients who had undergone surgery for HPT. After excluding revision surgical procedures, secondary and tertiary HPT, unavailable intraoperative parathyroid (PTH) data, concomitant thyroid disease requiring thyroidectomy, and patients without preoperative MIBI or US, 428 patients (58%) were included in the study.
  
  
  RESULTS
  The mean decrease in PTH level was 85%. Of the 428 patients with primary HPT included in the study, 209 patients (49%) had localizing, concordant preoperative MIBI and US. A decline of more than 50% in iPTH levels was observed in 202 patients (97%) after removal of parathyroid tissue localized by MIBI and US. The procedures for 4 patients were converted to bilateral neck explorations after the postexcision PTH level failed to drop less than 50%.
  
  
  CONCLUSIONS
  Our results show that iPTH monitoring may be eliminated in MIP surgery in a carefully selected group of patients who have preoperative, localizing MIBI with concordant US. This potentially allows an increase in operating room efficiency and a decrease in costs while performing MIP.
authors.affiliation: Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL 35233-6889, USA. njsmith17@hotmail.com
authors.forename: Nicholas
authors.initials: N
authors.lastname: Smith
authors.forename: Jeffrey Scott
authors.initials: JS
authors.lastname: Magnuson
authors.forename: David Macy
authors.initials: DM
authors.lastname: Vidrine
authors.forename: Brian
authors.initials: B
authors.lastname: Kulbersh
authors.forename: Glenn E
authors.initials: GE
authors.lastname: Peters
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000097:blood / Q000175:diagnosis / Q000601:surgery*; D007118:Immunoassay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D016343:Monitoring, Intraoperative / Q000379:methods*; D010281:Parathyroid Hormone / Q000097:blood*; D016105:Parathyroidectomy / Q000379:methods*; D049268:Positron-Emission Tomography; D011379:Prognosis; D012189:Retrospective Studies; D018615:Ultrasonography, Doppler, Color
chemical_list: D015415:Biomarkers; D010281:Parathyroid Hormone