A mini-invasive approach is feasible in patients with primary hyperparathyroidism and discordant or negative localisation studies

Background. A proper localisation of pathological parathyroid glands is essential for a minimally invasive approach in the surgical treatment of primary hyperparathyroidism (PHP). The recent introduction of portable mini gamma-cameras (pMGCs) enabled intraoperative scintigraphic scanning. The aim of our study is to evaluate the efficacy of this new method and compare it with the preoperative localisation surveys.Methods. 20 patients were studied; they were evaluated preoperatively by neck ultrasound andTc-sestaMIBI-scintigraphy and intraoperatively with the pMGC IP Guardian 2. The results obtained from the three evaluations were compared.Results. The pMGC presented a sensitivity of 95%, a specificity of 98.89%, and a diagnostic accuracy of 98.18%, which were higher than those of preoperative ultrasound (sensitivity 55%; specificity 95%; diagnostic accuracy 87%) and scintigraphy withTc-sestaMIBI (sensitivity 73.68%; specificity 96.05%; diagnostic accuracy 91.58%).Conclusions. The pMGC can be used effectively as an intraoperative method to find the correct location of the pathological parathyroid glands. The pMGC is more reliable than the currently used preoperative and intraoperative localisation techniques.

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Preoperative Parathyroid Needle Localization: A Minimally Invasive Novel Technique in Reoperative Settings

Minimally Invasive Surgery ◽

10.1155/2011/487076 ◽

2011 ◽

Vol 2011 ◽

pp. 1-4

Author(s):

Ryan Winters ◽

Paul Friedlander ◽

Salem Noureldine ◽

Ibrahim Ekaidi ◽

Krzysztof Moroz ◽

...

Keyword(s):

Primary Hyperparathyroidism ◽

Minimally Invasive ◽

Guide Wire ◽

Calcium Supplementation ◽

Surgical Excision ◽

Needle Aspiration ◽

Parathyroid Surgery ◽

Invasive Approach ◽

Needle Localization ◽

Serum Pth

Background. Reoperative parathyroid surgery for primary hyperparathyroidism can be challenging. Numerous preoperative localization techniques have been employed to facilitate a more focused surgical exploration. This paper describes a novel, minimally invasive, and highly successful method of parathyroid localization.Methods. Patients with recurrent or persistent primary hyperparathyroidism underwent parathyroidectomy following CT scan or ultrasound-guided wire localization of the parathyroid. Accurate placement was confirmed by fine-needle aspiration with immunocytochemistry or PTH washout. The guide wire was leftin situto guide surgical excision of the gland. Curative resection was established by monitoring intact serum PTH levels after excision of the adenoma.Results. All ten patients underwent successful redo-targeted parathyroidectomy. Nine of the ten patients were discharged on the day of surgery. One patient was observed overnight due to transient postoperative hypocalcemia, which resolved with calcium supplementation.Conclusion. Placement of a localization wire via preoperative high-resolution ultrasound or CT can expedite reoperative parathyroid surgery. It allows identification of parathyroid adenoma via a minimally invasive approach, especially in cases where a sestamibi scan is inconclusive.

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Primary Hyperparathyroidism in Older People: Surgical Treatment with Minimally Invasive Approaches and Outcome

International Journal of Endocrinology ◽

10.1155/2012/539542 ◽

2012 ◽

Vol 2012 ◽

pp. 1-6 ◽

Cited By ~ 6

Author(s):

Chiara Dobrinja ◽

Marta Silvestri ◽

Nicolò de Manzini

Keyword(s):

Primary Hyperparathyroidism ◽

Minimally Invasive ◽

Elderly Patients ◽

Average Length ◽

The Elderly ◽

Preoperative Imaging ◽

Minimally Invasive Approach ◽

Invasive Approach ◽

Average Length Of Stay ◽

Operative Findings

Introduction. Elderly patients with primary hyperparathyroidism (pHPT) are often not referred to surgery because of their associated comorbidities that may increase surgical risk. The aim of the study was to review indications and results of minimally invasive approach parathyroidectomy in elderly patients to evaluate its impact on outcome.Materials and Methods. All patients of 70 years of age or older undergoing minimally approach parathyroidectomy at our Department from May 2005 to May 2011 were reviewed. Data collected included patients demographic information, biochemical pathology, time elapsed from pHPT diagnosis to surgical intervention, operative findings, complications, and results of postoperative biochemical studies.Results and Discussion. 37 patients were analysed. The average length of stay was 2.8 days. 11 patients were discharged within 24 hours after their operation. Morbidity included 6 transient symptomatic postoperative hypocalcemias while one patient developed a transient laryngeal nerve palsy. Time elapsed from pHPT diagnosis to first surgical visit evidences that the elderly patients were referred after their disease had progressed.Conclusions. Our data show that minimally invasive approach to parathyroid surgery seems to be safe and curative also in elderly patients with few associated risks because of combination of modern preoperative imaging, advances in surgical technique, and advances in anesthesia care.

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