Minimally Invasive Radioguided Parathyroidectomy

Cox, Matthew D.; Stack, Brendan C.

doi:10.1007/978-3-319-26794-4_17

Cited by 2 publications

(5 citation statements)

References 88 publications

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“…Historically, bilateral exploration to locate all parathyroid glands prior to removal of one or more abnormal glands was routine 1 . Recent advancements in imaging, radioguidance with preoperative injection of technetium, and widespread use of rapid intraoperative parathyroid hormone (IOPTH) have led to less invasive, more focused surgical techniques 1,2 . These practices, referred to as minimally invasive parathyroid surgery or minimally invasive radio‐guided parathyroidectomy (MIRP), allow surgeons to preoperatively identify the correct side and, sometimes, correct quadrant, allowing for smaller incisions and, consequently, less disruption due to dissection of adjacent, high‐risk structures and normally functioning parathyroid glands 2 …”

Section: Introductionmentioning

confidence: 99%

“…Multiple studies have demonstrated high specificity of adenoma localization using these modalities, particularly 4DCT 3–8 . In addition, after excision of the offending parathyroid gland(s), a biochemical cure can be confirmed via changes in IOPTH values 1,2 …”

Section: Introductionmentioning

confidence: 99%

“…1 Recent advancements in imaging, radioguidance with preoperative injection of technetium, and widespread use of rapid intraoperative parathyroid hormone (IOPTH) have led to less invasive, more focused surgical techniques. 1,2 These practices, referred to as minimally invasive parathyroid surgery or minimally invasive radio-guided parathyroidectomy (MIRP), allow surgeons to preoperatively identify the correct side and, sometimes, correct quadrant, allowing for smaller incisions and, consequently, less disruption due to dissection of adjacent, high-risk structures and normally functioning parathyroid glands. 2 Methods for localizing target glands before surgery comprise a combination of techniques that identify a parathyroid target based on enlarged size or hyperfunction.…”

Section: Introductionmentioning

confidence: 99%

“…1,2 These practices, referred to as minimally invasive parathyroid surgery or minimally invasive radio-guided parathyroidectomy (MIRP), allow surgeons to preoperatively identify the correct side and, sometimes, correct quadrant, allowing for smaller incisions and, consequently, less disruption due to dissection of adjacent, high-risk structures and normally functioning parathyroid glands. 2 Methods for localizing target glands before surgery comprise a combination of techniques that identify a parathyroid target based on enlarged size or hyperfunction. These include preoperative neck ultrasound (NUS), 99mTc-sestamibi scintigraphy, 4D computed tomography (4DCT), or single-photon emission CT (SPECT) with or without concurrent conventional CT.…”

Section: Introductionmentioning

confidence: 99%

“…[3][4][5][6][7][8] In addition, after excision of the offending parathyroid gland(s), a biochemical cure can be confirmed via changes in IOPTH values. 1,2 Intraoperative scintigraphy (IoS) is an above-the-operating room (OR) table gamma camera on a boom that is capable of producing images similar to gamma images obtained via conventional pre-operative imaging. Several European studies have reported on the use of IoS for localizing an abnormal parathyroid, with a sensitivity/specificity >90%.…”

Section: Introductionmentioning

confidence: 99%

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Utility of intraoperative digital scintigraphy in radioguided parathyroidectomy

et al. 2021

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Background Intraoperative scintigraphy (IoS) has been proposed as a tool for real‐time intraoperative decision‐making regarding parathyroid adenoma localization and confirmation of excision. Methods Retrospective review of patients who underwent minimally invasive parathyroidectomies with scintigraphy performed intraoperatively. Preoperative neck ultrasound, 4D computed tomography, as well as intraoperative parathyroid hormone (IOPTH) and gamma probe measurements were conducted per standard practice. IoS images were obtained prior to and following parathyroid excision. Cases were reviewed to determine accuracy of IoS for localizing parathyroid pathology and confirming successful excision. Results Fifty‐six cases met the inclusion criteria. Twenty‐nine patients (51.8%) showed confirmation of excision of an abnormal gland on post‐excision IoS. There were no significant differences in IOPTH reduction and postoperative laboratory values between patients with IoS‐identified resolution and those without IoS‐identified resolution. Conclusions With low accuracy in correctly localizing abnormal glands and confirming their excision, there is no appreciable benefit of IoS at this time.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Utility of intraoperative digital scintigraphy in radioguided parathyroidectomy

et al. 2021

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AHNS Series: Do you know your guidelines? Optimizing outcomes in reoperative parathyroid surgery: Definitive multidisciplinary joint consensus guidelines of the American Head and Neck Society and the British Association of Endocrine and Thyroid Surgeons

et al. 2018

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Background Revision parathyroid is challenging due to possible diagnostic uncertainty as well as the technical challenges it can present. Methods A multidisciplinary panel of distinguished experts from the American Head and Neck Society (AHNS) Endocrine Section, the British Association of Endocrine and Thyroid Surgeons (BAETS), and other invited experts have reviewed this topic with the purpose of making recommendations based on current best evidence. The literature was also reviewed on May 12, 2017. PubMed (1946‐2017), Cochrane SR (2005‐2017), CT databases (1997‐2017), and Web of Science (1945‐2017) were searched with the following strategy: revision and reoperative parathyroidectomy to ensure completeness. Results Guideline recommendations were made in 3 domains: preoperative evaluation, surgical management, and alternatives to surgery. Eleven guideline recommendations are proposed. Conclusion Reoperative parathyroid surgery is best avoided if possible. Our literature search and subsequent recommendations found that these cases are best managed by experienced surgeons using precision preoperative localization, intraoperative parathyroid hormone (PTH), and the team approach.

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Minimally Invasive Radioguided Parathyroidectomy

Cited by 2 publications

References 88 publications

Utility of intraoperative digital scintigraphy in radioguided parathyroidectomy

Utility of intraoperative digital scintigraphy in radioguided parathyroidectomy

AHNS Series: Do you know your guidelines? Optimizing outcomes in reoperative parathyroid surgery: Definitive multidisciplinary joint consensus guidelines of the American Head and Neck Society and the British Association of Endocrine and Thyroid Surgeons

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