title: Radioguided occult lesion localization for minimally invasive parathyroidectomy: technical consideration and feasibility.
abstract: OBJECTIVE
  Minimally invasive parathyroidectomy (MIP) constitutes one of the main surgical approaches for the patient with primary hyperparathyroidism (PHPT) caused by a single parathyroid adenoma. The purpose of the study was to investigate the feasibility of radioguided occult lesion localization (ROLL) for MIP and the potential effects of the method in histopathologic evaluation.
  
  
  METHODS
  Twenty-two patients, diagnosed with PHPT biochemically and candidates for surgery, underwent ROLL-guided MIP (ROLL-MIP). Parathyroid adenomas were searched for and identified with the guidance of an intraoperative gamma probe. The final diagnosis was confirmed by histopathologic analysis. All specimens were analyzed for the presence of parenchymal hemorrhage, congestion, neutrophil leukocyte infiltration, necrosis, cystic degeneration, subcapsular hematoma, subcapsular fibrin/neutrophil leukocyte infiltration, and disarray of the fibrous capsule of adenoma.
  
  
  RESULTS
  All injected lesions were effectively located over the skin with very high count rates depending on the injected activity and location of the lesion. Serum calcium and parathyroid hormone (PTH) levels normalized in all patients and stayed within the normal range during the follow-up period. None of the patients who underwent ROLL-MIP suffered temporary or permanent recurrent laryngeal nerve injuries. The mean operative time was 23 ± 7 min. Parenchymal hemorrhage, congestion, subcapsular hematoma, and fibrin/neutrophil leukocyte infiltration were common histopathologic features.
  
  
  CONCLUSIONS
  The use of ROLL-MIP in patients with PHPT due to a single parathyroid adenoma in the neck is technically safe and effective. It is more valuable in scintigraphy-negative patients when parathyroid adenoma is either demonstrated on ultrasonography by typical findings or confirmed by PTH washout. The ROLL-MIP technique does not impair the postoperative histopathologic examination of the parathyroid glands.
authors.affiliation: Departments of aNuclear Medicine bEndocrine Surgery cPathology dEndocrinology, Güven Hospital, Ankara, Turkey.
authors.forename: Seyfettin
authors.initials: S
authors.lastname: Ilgan
authors.forename: Serdar
authors.initials: S
authors.lastname: Ozbas
authors.forename: Banu
authors.initials: B
authors.lastname: Bilezikci
authors.forename: Tugba
authors.initials: T
authors.lastname: Sengezer
authors.forename: Oguz Ugur
authors.initials: OU
authors.lastname: Aydin
authors.forename: Alptekin
authors.initials: A
authors.lastname: Gursoy
authors.forename: Savas
authors.initials: S
authors.lastname: Kocak
mesh_terms: D000328:Adult; D000368:Aged; D005240:Feasibility Studies; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D010282:Parathyroid Neoplasms / Q000150:complications; D016105:Parathyroidectomy / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome