Primer Hiperparatiroidizmde Cerrahi Tedavi: Kime Hangi Tedavi?

Abstract

Intraoperative Adjunct Methods for Localization in Primary Hyperparathyroidism T he curative treatment of primary hyperparathyroidism (pHPT) is surgery. The causative agent of the disease in pHPT is parathyroid adenomas originating from a single gland in 80-85% of the cases. After the third quarter of the last century, preoperative imaging methods have been rapidly developed, most of the pathological glands could be determined. In addition, intraoperative gamma probe application, ultrasonography (USG), methylene blue, and/ or frozen section examination are being used to increase the success in parathyroidectomy. Recently, promising studies regarding different parathyroid imaging modalities with optical technologies to identify the intraoperative parathyroid glands have been noteworthy. Currently, bilateral neck exploration (BNE) is the gold standard in the surgical treatment of pHPT. [1] However, with the contribution of imaging modalities and especially intraoperative parathyroid hormone (PTH) mea-Primary hyperparathyroidism (pHPT) is a frequently seen endocrine disease, and its main treatment is surgery. In the majority of pHPT, the disease involves only a single gland, and the majority of the pathological glands can be determined by preoperative localization methods.In addition to preoperative localization studies in parathyroidectomy, the use of adjunct methods to improve intraoperative localization in order to increase success of surgery is becoming widespread. These methods include different approaches, mainly intraoperative parathyroid hormone (PTH) measurement, followed by intraoperative gamma probe application, intraoperative ultrasonography, parathyroid imaging with methylene blue, and frozen section examination. Recently, especially promising new imaging methods have been described in the literature with various optical technologies to increase the localization of the parathyroid glands and to evaluate their viability. These methods include parathyroid imaging with autofluorescence, indocyanine green imaging with autofluorescence, autofluorescence imaging with methylene blue, autofluorescence imaging with 5-aminolevulinic acid, optical coherence tomography, laser speckle contrast imaging, dynamic optical contrast imaging, and Raman spectroscopy. Currently, minimally invasive parathyroidectomy has become the standard treatment for selected pHPT patients with the aid of preoperative imaging and intraoperative auxiliary methods. The aim of the present study was to evaluate the routinely used new promising intraoperative adjunct methods in pHPT.

Primer Hiperparatiroidili Hastalarda Preoperatif Ultrasonografi Ve Sintigrafinin İlk Görüntülemede Patolojik Bezin Lokalizasyonunda Etkinliği

“…Although BNE is currently the gold standard therapy in the treatment of pHPT, MIP has become the standard treatment option in selected patients with positive imaging. [10] The cure rate in selected patients with MIP was similar to that of BNE. It has been reported that patients with MIP have less total complication rates, shorter operative time, lower postoperative pain, less analgesic requirement, shorter hospital stay, and better cosmetic outcome and less fibrosis in the early period than BNE.…”

Video-assisted thoracoscopic surgery for primary hyperparathyroidism with ectopic parathyroid adenoma in thymus

“…Inferior parathyroid glands and thymus both originate from the third pharyngeal arch [3,6,13]. Other common localizations of ectopic parathyroid tissue include mediastinum, thyroid gland, and parapharyngeal space [3,9,[14][15][16][17]. Signs and symptoms of hyperparathyroidism can also be the first presentation of multiple endocrine neoplasia type 1 (MEN1).…”

“…Bilateral four-gland neck exploration was the most commonly used surgical technique for treating hyperparathyroidism [16]. Unilateral neck exploration is considered appropriate in asymptomatic patients with mild forms of primary hyperparathyroidism [16,19].…”

“…Open cervical approach (collar incision by Kocher) can also be used for mediastinal adenomas located in close relation to the aortic arch, or more cranially located masses [3,16].…”

Clinical adaptation of auxiliary methods and multidisciplinary approach to changing trends in parathyroid surgery

“…While the use of an intraoperative gamma probe (IO-GP) is a helpful guide in finding the pathological gland, intraoperative parathormon (IO-PTH) allows us to make sure that the pathological gland is removed and to safely terminate the operation. [ 13 ]…”