Minimally invasive radioguided parathyroidectomy in the reoperative neck

Norman, James; Denham, Daphne W.

doi:10.1067/msy.1998.92007

Cited by 147 publications

(84 citation statements)

References 8 publications

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“…Interestingly, Jaskowiak et al (27), proposed a four-point scale to define the probe-guided surgery in a group of 54 patients treated by BNE: the probe was judged crucial in only two patients (4%), helpful in 12 (22%), merely confirmatory in 32 (59%) and not helpful in eight (15%). In contrast, in our experience as well as in that of Norman et al (7,26,28) the probe was helpful in the majority of scan-positive patients and very helpful or even crucial in patients with adenomas located in ectopic sites or deep in the para-tracheal/ para-esophageal space. This difference in judging probe utility could be related, at least in part, to the different surgical approaches utilized: a BNE in Jaskowiak's study (27) while a MIRS in our own study and in Norman's studies (7,26,28).…”

Section: Discussioncontrasting

confidence: 52%

“…In contrast, in our experience as well as in that of Norman et al (7,26,28) the probe was helpful in the majority of scan-positive patients and very helpful or even crucial in patients with adenomas located in ectopic sites or deep in the para-tracheal/ para-esophageal space. This difference in judging probe utility could be related, at least in part, to the different surgical approaches utilized: a BNE in Jaskowiak's study (27) while a MIRS in our own study and in Norman's studies (7,26,28). From this view, it appears reasonable to think that it can be relatively easy for an experienced surgeon to detect a parathyroid adenoma located in an orthotopic site during a BNE simply using the 'eyes'; conversely, it can be difficult, even for an experienced surgeon, to detect a parathyroid adenoma through a 2 cm skin incision without the help of a 'gamma probe': thus, following Jaskowiak's criteria (27) what is judged as 'merely confirmatory' during a BNE could be 'helpful' during a MIRS and what is judged as 'helpful' during a BNE could be 'crucial' during a MIRS.…”

Section: Discussioncontrasting

confidence: 52%

“…This discrepancy might be explained, at least in part, by considering the relatively lower sensitivity of the preoperative scintigraphy used by Bonjer et al (31) and Jaskowiak et al (27) (dual-phase technique) in comparison with our scintigraphic procedure (double-tracer technique): sensitivity for detection of parathyroid adenomas was 60 -74% vs 95% respectively. It appears surprising that such different and opposite opinions have been reported in the literature on the role of the gamma probe during parathyroidectomy, ranging from enthusiastic considerations (7,26,28), to less favorable results (16,27), to a judgment of uselessness (32). Some explanations can be made.…”

Section: Discussionmentioning

confidence: 89%

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Role of gamma probes in performing minimally invasive parathyroidectomy in patients with primary hyperparathyroidism: optimization of preoperative and intraoperative procedures

Rubello

Piotto²,

Casara³

et al. 2003

European Journal of Endocrinology

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Objective: In the last decade, surgery of primary hyperparathyroidism (HPT) due to a solitary adenoma has moved on from the traditional wide bilateral neck exploration (BNE) to more limited approaches such as unilateral neck exploration and minimally invasive parathyroidectomy. Design: To define the role of intraoperative gamma probe and injection of a low 99m Tc-MIBI dose in performing minimally invasive radio-guided surgery (MIRS) in HPT patients with a solitary parathyroid adenoma. Methods: From September 1999 to July 2002, 214 patients with primary HPT entered the study. All patients were preoperatively investigated by a 99m Tc-pertechnetate/MIBI subtraction scan and high-resolution neck ultrasound. The intraoperative technique we developed differs from other previously described techniques being based on the injection of a low (37 MBq) MIBI dose in the operating theatre a few minutes before the beginning of intervention. Results: On the basis of scan/ultrasound findings 147 patients were selected for a MIRS and 144 of them (98%) were successfully treated by this approach: a solitary parathyroid adenoma was removed through a small 2-2.5 cm skin incision with a mean operative time of 35 min, and a mean hospital stay of 1.2 days. In the other 67 patients with scan/ultrasound evidence of concomitant nodular goiter (n ¼ 45) or multi-gland disease (n ¼ 13) or with a negative scan (n ¼ 9), the gamma probe was utilized during a traditional BNE. A low 37 MBq MIBI dose proved to be sufficient to perform a MIRS; moreover it delivered to the patient and surgeon a low, negligible, radiation exposure dose. Conclusions: The combination of a 99m Tc-pertechnetate/MIBI subtraction scan and neck ultrasound appears to be an accurate imaging protocol in selecting primary HPT patients as candidates for a MIRS. A MIBI dose as low as 37 MBq injected in the operating theatre just before the start of surgery appears to be adequate to perform radio-guided surgery.

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Section: Discussioncontrasting

confidence: 52%

Section: Discussioncontrasting

confidence: 52%

Section: Discussionmentioning

confidence: 89%

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Role of gamma probes in performing minimally invasive parathyroidectomy in patients with primary hyperparathyroidism: optimization of preoperative and intraoperative procedures

Rubello

Piotto²,

Casara³

et al. 2003

European Journal of Endocrinology

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“…The first attempts at performing MIP in a previously operated neck date back to 1997 when Rotstein and Norman reported success rates of 93% and 100% with the use of gamma probe or IOPTHA. 14,15 It should however be emphasized that the role of quick iPTH assay is still controversial for cost reasons, especially when two concordant results of preoperative imaging tests are available, although it is noteworthy that up to 5% of patients can still benefit. 16,17 The term PNS or reoperative neck can be divided into two groups.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive parathyroidectomy in patients with previous neck surgery

Dimas¹,

Michas²,

Christakis³

et al. 2012

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ObJEctIVE: Previous neck surgery (PNs) in patients with primary hyperparathyroidism (PHP) is considered as a contraindication for minimally invasive parathyroidectomy (MIP). the purpose of our study was to determine the effectiveness of MIP in such patients. DEsIGN: From January 2003 to June 2011, 380 patients with PHP were treated in our department; 42 had had previous neck surgery. twenty-seven (27/42) were selected to have MIP; the remaining 15 patients had traditional neck explorations. selection criteria for MIP were unilateral single or two gland disease localized preoperatively with at least two imaging techniques and patient's informed consent. Imaging studies included high resolution neck ultrasound and sestamibi scan in the majority, and ct scan, selective venous sampling and MrI in seven patients. the type of operation done included unilateral approach under local anesthesia (UALA) (22 cases) with one conversion to general anesthesia and minimally invasive parathyroidectomy under general anesthesia (MIPG) (5 cases). rEsULts: twenty-six of the 27 patients became normocalcemic after the operation. the patient with persistent hypercalcemia underwent successful parathyroidectomy 8 months later via mesothoracoscopy, since the parathyroid gland was localized correctly but was beyond access via neck. A single adenoma was found in 21 cases and hyperplasia in six. there were no conversions to traditional exploration and no postoperative complications. Mean duration of the procedure and length of stay were similar to MIP in patients without PNs. Mean follow-up of 40 months (4-89 months) did not reveal any recurrence. cONcLUsION: these results illustrate that MIP is a valuable option in selected patients with PHP and PNs associated with no morbidity (0%), high biochemical cure rate (96.3% in this series) and rapid recovery, while it also substantially lowers the cost of the procedure. Preoperative localization with two or more agreeing imaging techniques eliminates the need for intraoperative sestamibi or qPtH test.

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“…To perform VATS, three to four trocars are inserted between the fourth and seventh ribs via a lateral approach, and the masses are identified based on the diagnostic imaging, and excised by the shortest possible route. The effectiveness of the technique for intraoperatively identifying parathyroid lesions has been well documented since Norman and Denham introduced radioisotope navigation using MIBI for videoassisted thoracic parathyroidectomy [47].…”

Section: Minimally Invasive Parathyroidectomymentioning

confidence: 99%