Role of gamma probes in performing minimally invasive parathyroidectomy in patients with primary hyperparathyroidism: optimization of preoperative and intraoperative procedures (original) (raw)
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Polish Journal of Surgery, 2008
The aim of the study was to present the experience of the authors in employing minimally invasive radio-guided parathyroid reoperative surgery (MIRP) combined with intraoperative iPTH assay (IOPTH) in persistent and recurrent primary hyperparathyroidism (PHP) and in patients with a history of thyroidectomy. Material and methods. A prospective analysis included the results of 12 reoperations performed employing the minimally invasive method using an intraoperative hand-held gamma camera (Gamma Finder II) following IV administration of 10 mCi 99m Tc-MIBI, combined with IOPTH (Future Diagnostics) in six patients with persistent PHP, one patient with recurrent PHP and five patients after subtotal strumectomies without planned parathyroidectomies (F : M = 10 : 2; mean age 54±10.7 years; mean preoperative iPTH concentration 233.3±80.6 ng/L). Prior to surgery, all the patients had been subjected to diagnostic imaging studies (parathyroid scintiscans, USG of the neck, in selected cases, SPECT and CT of the neck and mediastinum). The validity of MIRP and IOPTH in minimizing the extent of intraoperative neck exploration was assessed. Therapeutic results were evaluated in six-month postoperative follow-up. Results. All the patients were cured. The mean incision length was 3.5±0.5 cm. The mean operative time was 49±10 min. All the patients had a single parathyroid adenoma (in five cases-in the tracheoesophageal groove, in 3-in the retroesophageal region in the neck, in one-in the retroesophageal region in the superior posterior mediastinum, in one-in the thyrothymic ligament and in two-in the thymus). The mean ratio of adenoma to background neck radioactivity was 25.7±5.4%. The mean iPTH concentration 10 min after adenoma resection was 38.5±17.4 ng/L. No postoperative complications were noted. In six-month postoperative follow-up, all the patients demonstrated normal serum calcium values. Conclusions. MIRP has proven to be highly successful in reoperations in patients with PHP. The procedure performed using a hand-held gamma camera allows for a safe execution of a minimally invasive procedure focused on resection of a single parathyroid adenoma, eliminating the need for bilateral neck exploration, which is extensive, time-consuming and associated with a higher risk of damaging the recurrent laryngeal nerve and normal parathyroids.
99MTc-mibi Radio-guided Surgery in Primary Hyperparathyroidism: A Prospective Study of 128 Patients
Tumori Journal, 2002
Aims and study design We investigated the role of an intraoperative gamma probe (IGP) technique in 128 patients with primary hyperparathyroidism (HPT). The patients were evaluated before surgery by 99mTcO4/MIBI scintigraphy and neck ultrasound and then operated on by the same surgical team. The IGP technique consisted of the injection of a low dose (37 MBq) of 99mTc-MIBI in the operating room shortly before the start of surgery. Quick parathyroid hormone (QPTH) was routinely measured during the operation. Results In 94/97 patients (96.9%) with a preoperative diagnosis of solitary parathyroid adenoma (PA) minimally invasive radioguided surgery (MIRS) was successfully performed; in the other 3/97 patients (3.1%) conversion to bilateral neck exploration (BNE) was required because of the intraoperative diagnosis of parathyroid carcinoma in two cases and multiglandular disease (MGD) in one. MIRS was successfully performed also in 23 patients who had undergone previous thyroid or parathyr...
Journal of Medical Radiation Sciences, 2013
The use of technetium-99m 2-methoxyisobutyl isonitrile (99m Tc MIBI) for assistance in minimally invasive radioguided surgery (MIRS) is growing in popularity as a safe, effective, and proficient technique used for parathyroidectomy in primary hyperparathyroidism (PHPT) treatment. Previously, the preferred treatment for PHPT was bilateral neck exploration (BNE), a very invasive, costly, and lengthy procedure. However, as a large majority (80-85% of cases of PHPT) are attributed to a single parathyroid adenoma (PA), a simpler more direct technique such as MIRS is a far better option. The following article is an exploration of the current literature concerning varied protocols utilizing 99m Tc MIBI for assistance in MIRS for patients undergoing treatment of PHPT. This technique boasts many advantageous outcomes for patients suffering from PHPT. These include a reduction in cost, operating time, and patient recovery; less evidence of post-surgical hypocalcaemia, less pain, and complications; superior cosmetic results; same-day discharge; and the possibility of local anaesthesia which is particularly beneficial in elderly patients. Better outcomes for patients with deep or ectopic PAs, reduced intra-operative complications, and improved cosmetic outcomes for patients who have previously undergone thyroid and/or parathyroid surgery are also advantageous. Of the literature reviewed it was also found that no patients suffered any major surgical complications such as laryngeal nerve palsy or permanent hypoparathyroidism using 99m Tc MIBI for assistance in MIRS.
Minimally invasive radioguided parathyroidectomy
Biomedicine & Pharmacotherapy, 2006
The surgical management of hyperparathyroidism has evolved over the last 20 years, transitioning from routine bilateral neck exploration to, frequently, a minimally invasive approach. Adjuncts which have made this transition possible include advancements in imaging techniques which allow the pre-operative localization of adenomatous glands, the rapid parathyroid hormone assay and the use of 99-m technetium sestamibi injections the day of surgery to allow for gamma probe detection of abnormal glands. The gamma probe can help with gland localization, which can be particularly useful in a reoperative field or with glands in ectopic locations. It is also helpful in confirming that excised tissue is abnormal parathyroid tissue, alleviating the need for frozen sections during surgery. In this chapter we discuss and review radioguided minimally invasive parathyroidectomy.
Revision parathyroidectomy guided by intraoperative radionuclide imaging
The Israel Medical Association journal : IMAJ, 2003
BACKGROUND Technetium-99m sestamibi scintigraphy has become one of the most popular techniques for localization of the parathyroid gland after failure of primary neck exploration. OBJECTIVE To examine the efficacy of sestamibi with the hand-held gamma ray detecting probe for the identification of parathyroid adenomas during revision parathyroidectomy. METHODS We reviewed six cases of probe-assisted neck exploration for parathyroid lesions following unsuccessful primary exploration. RESULTS In all cases the pathologic glands were successfully detected and removed. CONCLUSIONS With careful planning, a gamma ray detecting probe can be used optimally 2-3 hours after technetium-99m sestamibi injection. The probe is efficient, easy and convenient to use.
2015
This study evaluated the accuracy of 99mTc-sestamibi scintigra-phy and neck ultrasonography in patients with primary hyper-parathyroidism (PHPT) and the role of intraoperative hand-held -probes in minimally invasive radioguided surgery (MIRS) of patients with a high likelihood of a solitary parathyroid adenoma (PA). The study was undertaken under the aegis of the Italian Study Group on Radioguided Surgery and Immunoscintigraphy (GISCRIS). Methods: Clinical records were reviewed for 384 consecutive PHPT patients undergoing radioguided surgery us-ing a low dose of 99mTc-sestamibi. Selection of patients for MIRS instead of traditional bilateral neck exploration was based on preoperative imaging indicating a solitary PA. 99mTc-Sesta-mibi (37–110 MBq, or 1–3 mCi) was injected in the operating theater 10–30 min before the start of the intervention. Either 11-mm collimated (309 patients) or 14-mm collimated (75 pa-