Unilateral Parathyroidectomy in Hyperparathyroidism Due to Single Adenoma

Tibblin, S; Bondeson, Anne‐Greth; Ljungberg, Otto

doi:10.1097/00000658-198203000-00001

Cited by 237 publications

(119 citation statements)

References 14 publications

Supporting

Mentioning

104

Contrasting

Unclassified

Order By: Relevance

“…PHPT'nin en sık nedeni olan tek adenomlarda gittikçe artan biçimde tercih edilen cerrahi yöntem, ilk kez Tibblin tarafından tanımlanan MİP'dir. 4 MİP tekniğinin cerrahi kür başarısını etkileyen en önemli faktör, preoperatif görüntüleme tekniklerinin etkin kullanımıdır. Lokalizasyon için en çok tercih edilen görüntüleme teknikleri USG ile Tc-99m MIBI sintigrafisidir.…”

Section: Discussionunclassified

The Use of ROLL Technique in Recurrent Hyperparathyroidism Due to Double Parathyroid Adenoma: Case Report

Aydın¹,

Küçükel²,

Soylu³

et al. 2015

Turkiye Klinikleri J Endocrin

View full text Add to dashboard Cite

P rimer hiperparatiroidi (PHPT); benign hiperkalseminin en sık nedenidir ve paratiroid bezlerinden aşırı parathormon (PTH) salınımı ile karakterizedir. PHPT olgularının yaklaşık %80-85'inde neden sporadik, tek paratiroid adenomudur. Olguların kalan kısmında ise neden, sı-rasıyla multiglandüler hiperplazi, çift adenomlar ve nadiren paratiroid karsinomlarıdır.1 PHPT'de cerrahi, hâlen başlıca tedavi yöntemi olma özel-liğini korumaktadır. Tüm paratiroid bezlerinin izlenmesine dayalı bilateral Turkiye Klinikleri J Endocrin 2015;10(1) 31Çift Paratiroid Adenomu Nedeni ile Nüks Hiperparatiroidide ROLL Tekniğinin Kullanımı Ö ÖZ ZE ET T Primer hiperparatiroidi (PHPT); benign hiperkalseminin en sık nedenidir ve paratiroid bezlerinden aşırı parathormon (PTH) salınımı ile karakterizedir. PHPT olgularının yaklaşık %80-85'inde neden sporadik, tek paratiroid adenomudur. PHPT'de cerrahi, hâlen başlıca tedavi yöntemi olma özelliğini korumaktadır. Tek adenomlarda unilateral sınırlı cerrahi yaklaşım (minimal invaziv paratiroidektomi) giderek daha geniş kabul görmeye başlamıştır. Bu çalışmada, insidental tek paratiroid adenomu nedeni ile opere edilen ve erken dönemde nüks hiperparatiroidi gelişen bir olgu sunulmuştur. Klinik bulgular ve görüntüleme sonuçlarına göre nüks hiperparatiroidi sebebinin aynı lojda ikinci bir paratiroid adenomu olduğu anlaşılmış ve ikinci paratiroid adenomunun tedavisinde yardımcı bir cerrahi teknik olan "radioguided occult lesion localization (ROLL)" yöntemi kullanıl-mıştır. Bu çalışmada, paratiroid adenomlarının preoperatif görüntülenmesinde kullanılan yöntem-ler, görüntülemede hata kaynakları ve paratiroid cerrahisinde ROLL yönteminin kullanımı tartışılmıştır.A An na ah h t ta ar r K Ke e l li i m me e l le er r: : Hiperparatiroidizm; hiperkalsemi; paratiroid tümörleri A AB BS S T TR RA AC CT T Primary hyperparathyroidism (PHPT), resulting mainly 80-85% from sporadic, single parathyroid adenomas, is a clinical condition characterized by excessive excretion of parathormone (PTH) from parathyroid glands. Surgery continues to remain the mainstay of treatment for PHPT. The unilateral focused surgical approach, so called minimally invasive parathyroidectomy, has gained wide acceptance in cases of solitary parathyroid adenomas, which is the most common scenario. Authors present a primary hyperparathyroidism case due to single parathyroid adenoma who recurred at early stage after first surgical intervention. Second adenoma that detected in the same location treated surgically with the help of radioguided occult lesion localization (ROLL) technique. Second lesion accepted as double parathyroid adenoma according to clinical and imaging studies, subsequently. In this case report, imaging techniques used in parathyroid ima-ging, potential sources of errors and use of ROLL technique in parathyroid surgery discussed. Ya zış ma Ad re si/Cor res pon den ce:

show abstract

Section: Discussionunclassified

The Use of ROLL Technique in Recurrent Hyperparathyroidism Due to Double Parathyroid Adenoma: Case Report

Aydın¹,

Küçükel²,

Soylu³

et al. 2015

Turkiye Klinikleri J Endocrin

View full text Add to dashboard Cite

show abstract

“…For these reasons, parathyroid surgery has progressively moved towards some type of limited neck exploration. The first attempt was made in the early 1980s by Tibblin et al (5) who proposed a unilateral neck exploration (UNE) based on parathyroid adenoma removal and biopsy of the ipsilateral parathyroid gland to discover possible hyperplasia. In the 1990s UNE evolved towards even more limited surgical approaches: the endoscopic (6) and the radio-guided (7) minimally invasive parathyroidectomy.…”

Section: Introductionmentioning

confidence: 99%

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

View full text Add to dashboard Cite

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.

show abstract

“…In 1986, John L Doppman stated 'In my opinion, the only localizing study indicated in a patient with untreated primary hyperparathyroidism (pHPT) is to localize an experienced parathyroid surgeon'. At the same period, some surgeons had developed unilateral parathyroidectomy due to the high frequency of single adenomas (1). The improved performance of radiological and functional investigations has enabled the development of image-guided focused approaches.…”

Section: Introductionmentioning

confidence: 99%

Preoperative imaging for focused parathyroidectomy: making a good strategy even better

Guérin

Lowery

Gabriel

et al. 2015

European Journal of Endocrinology

View full text Add to dashboard Cite

Objective: Surgical treatment for primary hyperparathyroidism (pHPT) has undergone a major paradigm shift during the last decades from bilateral cervicotomy with four-gland neck exploration to image-guided focused approaches. The primary objective of the present study was to compare the performances of parathyroid scintigraphy (PS), parathyroid ultrasonography (US), and the combination of both procedures for guiding a focused approach on the basis of modified interpretation criteria. Methods: Data from 199 patients operated for apparent sporadic pHPT and evaluated with US and PS using dual-isotope 123 I/ 99m Tc-sestamibi planar pinhole and single-photon emission computed tomography (SPECT) acqusitions were evaluated. Results: A total of 127 patients underwent a focused approach and the remainder had bilateral cervicotomy. In 42 cases, a focused approach was not performed due to the absence of concordant results between US and PS for a single-gland abnormality. Four patients had persistent disease and three had recurrent disease. A localizing preoperative PS had a sensitivity of 93.3%, positive predictive value of 85.8%, negative predictive value of 73.0%, and accuracy of 83.4% for predicting uniglandular disease. Additional SPECT images accurately localize posterior adenomas that are often missed by US. Compared with PS, US had a lower sensitivity (P!0.01). Our imaging protocol also enabled diagnosis of multiglandular disease in 60.6%. Conclusions: PS using a highly sensitive dual-tracer subtraction method is the most accurate technique for directing a focused approach. PS could be sufficient for directing a focused approach in the presence of a negative US in two major circumstances: posterior locations due to acquired ectopia that could be missed by US, and previous history of thyroidectomy due to interpretation difficulties.

show abstract

Unilateral Parathyroidectomy in Hyperparathyroidism Due to Single Adenoma

Cited by 237 publications

References 14 publications

The Use of ROLL Technique in Recurrent Hyperparathyroidism Due to Double Parathyroid Adenoma: Case Report

The Use of ROLL Technique in Recurrent Hyperparathyroidism Due to Double Parathyroid Adenoma: Case Report

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

Preoperative imaging for focused parathyroidectomy: making a good strategy even better

Contact Info

Product

Resources

About