Minimally invasive parathyroidectomy with operative ultrasound localization of the adenoma

Kell, Malcolm R.; Sweeney, Karl; Moran, Cathal J.; Flanagan, F.; Kerin, Michael J.; Gorey, T. F.

doi:10.1007/s00464-003-9228-0

Cited by 15 publications

(4 citation statements)

References 5 publications

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“…Up to 90% of parathyroid adenomas can be visualized with ultrasound. We previously suggested intraoperative ultrasonograpy as a viable localizing modality 4. Herein we confirm that intraoperative ultrasonography can be used to complement or replace standard imaging for the localization of parathyroid adenomas.…”

Section: Introductionsupporting

confidence: 73%

Minimally Invasive Parathyroidectomy Using Surgical Sonography

Sadik¹,

Kell²,

Gorey³

2011

Int. J. Med. Sci.

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Minimally invasive parathyroidectomy is the procedure of choice for primary hyperparathyroidism due to parathyroid adenoma. Localization of the offending adenoma in minimally invasive parathyroidectomy (MIP) has been described in the literature aided by isotope, telescope or ultrasound guidance. We present a prospective study of two techniques based on surgeon experience. Thirty patients diagnosed with primary hyperparathyroidism at the Mater hospital in Dublin, Ireland were randomized to have a minimally invasive parathyroidectomy using surgical sonography (MIPUSS) or the conventional unilateral open procedure (OP) over a two year period. The age, sex and serum calcium/parathormone were comparable in both groups. There was no significant difference in complications between the two groups with temporary hypocalcemia occurring in 3 patients undergoing unilateral neck exploration and in 2 MIPUSS patients. There was one transient episode of recurrent laryngeal neuropraxia occurring in the OP group which resolved at 30 day follow-up. The incision size, operating time, hospital stay, and required post-operative analgesia were all markedly reduced in the MIPUSS group. In conclusion, MIPUSS is safe, effective and has advantages in terms of operating time, incision size and early discharge.

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Section: Introductionsupporting

confidence: 73%

Minimally Invasive Parathyroidectomy Using Surgical Sonography

Sadik¹,

Kell²,

Gorey³

2011

Int. J. Med. Sci.

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“…With the predominance of single‐gland disease in 85–96% of cases, a focused parathyroidectomy with minimally invasive techniques has become the initial treatment choice for PHPT . With this strategy, surgeons are reliant on accurate pre‐operative localization with modalities such as high‐resolution US, single photon emission computed tomography (CT), 99 mTc‐sestamibi (MIBI) imaging and 4D CT being the most popular . In addition, many surgeons utilize IOPTH monitoring as an adjunct to improve surgical outcomes.…”

Section: Discussionmentioning

confidence: 99%

Surgery for parathyroid microadenomas: patient characteristics, localization success and operative cures

Suter

Johnson

Yeung

et al. 2016

ANZ Journal of Surgery

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“…The technique for utilizing MIBI and a HGDP was first described by our group in 1995 [ 22 ]. Furthermore, the addition of intraoperative ultrasound to the HGDP further improved the sensitivity and specificity for determining successful surgical cure [ 5 , 8 , 13 , 17 – 19 , 21 , 23 – 27 ]. For some institutions, MIRP has become the standard of care for the treatment of PHPT due to its improved success rates, reduced morbidity, increased patient satisfaction, and cost effectiveness when compared to traditional bilateral neck exploration [ 8 , 21 , 26 , 28 ].…”

Section: Introductionmentioning

confidence: 99%

Intraoperative Scintigraphy Using a Large Field-of-View Portable Gamma Camera for Primary Hyperparathyroidism: Initial Experience

Hall

Plews

Agrawal

et al. 2015

BioMed Research International

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Background. We investigated a novel technique, intraoperative 99 Tc-Sestamibi (MIBI) imaging (neck and excised specimen (ES)), using a large field-of-view portable gamma camera (LFOVGC), for expediting confirmation of MIBI-avid parathyroid adenoma removal. Methods. Twenty patients with MIBI-avid parathyroid adenomas were preoperatively administered MIBI and intraoperatively imaged prior to incision (neck) and immediately following resection (neck and/or ES). Preoperative and intraoperative serum parathyroid hormone monitoring (IOPTH) and pathology (path) were also performed. Results. MIBI neck activity was absent and specimen activity was present in 13/20 with imaging after initial ES removal. In the remaining 7/20 cases, residual neck activity and/or absent ES activity prompted excision of additional tissue, ultimately leading to complete hyperfunctioning tissue excision. Postexcision LFOVGC ES imaging confirmed parathyroid adenoma resection 100% when postresection imaging qualitatively had activity (ES) and/or no activity (neck). The mean ± SEM time saving using intraoperative LFOVGC data to confirm resection versus first IOPTH or path result would have been 22.0 ± 2 minutes (specimen imaging) and 26.0 ± 3 minutes (neck imaging). Conclusion. Utilization of a novel real-time intraoperative LFOVGC imaging approach can provide confirmation of MIBI-avid parathyroid adenoma removal appreciably faster than IOPTH and/or path and may provide a valuable adjunct to parathyroid surgery.

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Minimally invasive parathyroidectomy with operative ultrasound localization of the adenoma

Abstract: The use of intraoperative ultrasound facilitates minimally invasive parathyroidectomy and may obviate the need for intraoperative 99mTc sestamibi scanning.

Cited by 15 publications

References 5 publications

Minimally Invasive Parathyroidectomy Using Surgical Sonography

Minimally Invasive Parathyroidectomy Using Surgical Sonography

Surgery for parathyroid microadenomas: patient characteristics, localization success and operative cures

Intraoperative Scintigraphy Using a Large Field-of-View Portable Gamma Camera for Primary Hyperparathyroidism: Initial Experience

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