Outcomes analysis of intraoperative adjuncts during minimally invasive parathyroidectomy for primary hyperparathyroidism

Nagar, Sapna; Reid, Daryl; Czako, Peter; Long, Graham W.; Shanley, Charles J.

doi:10.1016/j.amjsurg.2010.10.015

Cited by 23 publications

(33 citation statements)

References 20 publications

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“…Proponents for IOPTH measurement during FPTX claim decreased persistence rates, whereas opponents are concerned about unnecessary exploration due to falsenegative IOPTH drops, increased operative time and an increased risk of surgical complications, and decreased cost-efficiency. 6,7,[17][18][19][20][21][22][23] Despite the benefits of FPTX, recent studies have questioned its durability with lower long-term cure rates than bilateral exploration. A recent retrospective study of 15,000 parathyroidectomies showed a significant increase in recurrence after FPTX compared with OPTX.…”

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confidence: 98%

No Need to Abandon Focused Parathyroidectomy

et al. 2015

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confidence: 98%

No Need to Abandon Focused Parathyroidectomy

et al. 2015

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“…(2, 15–17) Technetium-99m sestamibi radioguidance, when used as an adjunct to minimally invasive parathyroidectomy (MIP), has been linked to a reduction in conversion to bilateral exploration, operative time, lengths of stay, and total operative and hospital costs. (1, 10) When initially introduced, the high avidity of hyperfunctioning parathyroid tissue for the technetium-99m sestamibi radionuclide allowed surgeons to accurately identify excised parathyroid tissue as such (and not thyroid, normal parathyroid, adipose, or other) without requiring frozen sections for confirmation. (15) Since the introduction of RGP to the surgeon's armamentarium, it has been shown to be particularly effective in detecting remaining abnormal glands at reoperation for persistent or recurrent disease in adults.…”

Section: Discussionmentioning

confidence: 99%

“…(1–3) PHPT affects 28 in 100,000 people, with 100,000 new cases each year; however, the diagnosis of pHPT is much rarer in children than in adults. (4–7) Surgical removal of the abnormal parathyroid gland is the only effective cure.…”

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confidence: 99%

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Radioguided parathyroidectomy effective in pediatric patients

Burke

Jacobson

Gosain

et al. 2013

Journal of Surgical Research

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Introduction Radioguided parathyroidectomy (RGP) has been shown to be effective in adult patients with hyperparathyroidism (HPT), but the utility of RGP in pediatric patients has not been systematically examined. It is not known if adult criteria for radioactive counts can accurately detect hyperfunctioning parathyroid glands in pediatric patients. The purpose of our study was to determine the utility of RGP in children with primary hyperparathyroidism. Materials and Methods A retrospective review of our prospectively maintained single-institution database for patients who underwent a RGP for primary HPT identified 1694 adult and 19 pediatric patients age 19 years or younger. From the adult population, we selected a control group matched 3 to 1 for gland weight and gender, and compared pre- and post-operative lab values, surgical findings, pathology, and radioguidance values between this and the pediatric group. Results Excised glands from pediatric patients were smaller than those in the total adult population (437 ± 60 mg vs. 718 ± 31 mg, p=0.0004). When controlled for gland weight, ex vivo counts as a percentage of background were lower in the pediatric group (51 ± 5% vs. 91 ± 11%, p=0.04). However, ex vivo radionuclide counts >20% of the background were found in 100% of pediatric patients and 95% of the adult matched control group. Conclusions All pediatric patients met the adult detection criteria for parathyroid tissue removal when a RGP was performed, and 100% cure was achieved. We conclude RGP is a useful treatment option for pediatric patients with primary hyperparathyroidism.

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“…4 Diagnostic preoperative parathyroid hormone (PTH) levels are generally obtained using an automated analyzer in a core laboratory. 6 These 2 PTH measurement modalities both detect intact PTH in the sampled blood and have been shown to exhibit strong correlation. 6 These 2 PTH measurement modalities both detect intact PTH in the sampled blood and have been shown to exhibit strong correlation.…”

Section: Introductionmentioning

confidence: 99%

Baseline intraoperative intact parathyroid hormone levels in parathyroid surgery

et al. 2018

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Background We sought to evaluate the relationship between the preoperative core‐laboratory parathyroid hormone (CL‐PTH) level and the baseline intraoperative PTH (IOPTH) level and assess the impact of any differences on clinical decision making in consecutive surgical patients with primary hyperparathyroidism undergoing parathyroidectomy. Methods The CL‐PTH and baseline IOPTH levels were compared. The influence of relying on either the CL‐PTH or baseline PTH levels for intraoperative decision making was determined. Results Data were available for 316 patients. Baseline IOPTH measurements were usually higher than the CL‐PTH (247 patients; 78.2%) measurements, with a mean difference of 68.2 pg/mL (P < .001). Using the CL‐PTH as a surrogate for the baseline parathyroid hormone (PTH) would have prolonged the operation in 23 patients (7.3%). Conclusion Baseline point‐of‐care IOPTH levels were higher than the preoperative CL‐PTH levels in >75% of patients undergoing parathyroidectomy. Using the CL‐PTH in lieu of an IOPTH baseline value would prolong the operation in some patients.

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Outcomes analysis of intraoperative adjuncts during minimally invasive parathyroidectomy for primary hyperparathyroidism

Cited by 23 publications

References 20 publications

No Need to Abandon Focused Parathyroidectomy

No Need to Abandon Focused Parathyroidectomy

Radioguided parathyroidectomy effective in pediatric patients

Baseline intraoperative intact parathyroid hormone levels in parathyroid surgery

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