US-guided laser treatment of parathyroid adenomas

Abstract

Objective: To determine the clinical efficacy of laser ablation for the tredatment of primary hyperparathyroidism (pHPT). Materials and methods: Twelve patients with pHPT were treated with laser ablation. Energy was administered by means of 1.5 m optical fibers percutaneously placed into the target via 21 G needles. A laser ablation unit (EchoLaser X4, Esaote) applied 3 W power for 400-600 s/fiber/insertion to a total 3600-9000 Joules of energy. Patient serum parathyroid hormone (PTH) and calcium levels were checked at baseline and thereafter every 6 months. Patients were followed-up for 2 years with serologic and contrast-enhanced ultrasound. Therapeutic success was defined as normal PTH and calcium levels together with disappearance of nodule-related symptoms. Results: All procedures were performed in single session. Immediately following ablation, contrast enhanced ultrasound confirmed that all but one target had become avascular (technical success rate 11/12; 92%), remaining avascular at all follow-up ultrasound examinations, thereafter. The mean volume of parathyroid nodules decreased from 0.54 cc to 0.36 cc (72.0%). Serum PTH and calcium levels were significantly lower at 1, 12 and 24 m compared to baseline (p < 0.01). By 6 m, PTH and calcium returned to normal and were stable until 24 m in all successfully treated patients. All cases of hyperparathyroid-related symptoms resolved by 6 m (ostealgia [n ¼ 5], repeated renal colic [n ¼ 5], vomiting [n ¼ 3]). Only one patient (8%) reported transient dysphonia as a minor complication. Conclusion: Laser ablation of enlarged, symptomatic parathyroid glands is safe and well-tolerated and can produce long-term, sustained reduction of serum PTH and calcium levels.

A study on the causes of operative failures after microwave ablation for primary hyperparathyroidism

“…In recent years, US-guided thermal ablation for pHPT has been demonstrated to be a promising option because of its minimal invasiveness, safety, promising efficacy, wide indications, and rapid postoperative recovery [8][9][10][11][12]. However, the cure rate of MWA is approximately 82.1-89.4%, and still there are some patients have failed procedures [9][10][11].…”

“…Surgical resection is recommended as the definitive curative treatment for pHPT [5][6][7]. In recent years, after more than a decade of clinical application, ultrasound-guided thermal ablation has been demonstrated to be effective in inactivating parathyroid nodules and normalizing serum PTH and calcium levels [8][9][10][11][12]. A recent prospective study showed that microwave ablation (MWA) and surgical resection provided comparable results in terms of cure rate in the treatment of pHPT [10].…”

Long-Term Efficacy of Ultrasound-Guided Percutaneous Laser Ablation for Low-Risk Papillary Thyroid Microcarcinoma: A 5-Year Follow-Up Study

“…As one of the most minimally invasive techniques for the removal of in situ tumors, ultrasound-guided percutaneous laser ablation (PLA) has been clinically applied for the treatment of various benign and malignant tumors [12][13][14][15]. Similar to ultrasound-guided radiofrequency ablation (RFA) and microwave ablation (MWA), PLA can generate a high temperature locally through energy, which leads to tissue thermal denaturation and coagulative necrosis.…”

Bone Turnover Markers in Response to Ultrasound-Guided Microwave Ablation for Primary Hyperparathyroidism

“…Thermal ablations have been used to treat primary hyperparathyroidism for a decade, including high-intensity focused ultrasound (HIFU) ( 9 , 11 ), laser ablation (LA) ( 10 , 12 , 17 ), radiofrequency ablation (RFA) ( 14 , 18 ) and MWA ( 13 , 15 , 19 , 21 ). Although their mechanisms to produce heat vary a lot, thermal ablation techniques produce heat to ablate lesions through a mechanism of tissue necrosis.…”