Article Commentary: Current Applications of the Intraoperative Parathyroid Hormone Assay in Parathyroid Surgery

2007 ◽  
Vol 73 (4) ◽  
pp. 311-317 ◽  
Author(s):  
Melanie L. Richards ◽  
Clive S. Grant
Keyword(s):  
Parathyroid Hormone ◽  
Minimally Invasive ◽  
Minimally Invasive Parathyroidectomy ◽  
Parathyroid Surgery ◽  
Invasive Parathyroidectomy ◽  
Parathyroid Disease ◽  
Parathyroid Hormone Assay ◽  
Marketing Tool ◽  
Intraoperative Parathyroid Hormone ◽  
Intraoperative Parathyroid Hormone Assay

Parathyroid hormone measurement using a two-site immunochemiluminometric assay has allowed for a rapid and accurate technique that has found its way into the operative armamentarium of some parathyroid surgeons. It can be used to assess the completeness of parathyroid gland resection and allow for a minimally invasive parathyroidectomy. This operative approach has become a popular marketing tool, providing patients with confidence in their surgical outcome. The purpose of this review is to provide the surgeon with the practical points and pitfalls of the use of intraoperative parathyroid hormone in the treatment of parathyroid disease.

scholarly journals Ultrasonography alone can reliably locate parathyroid tumours and facilitates minimally invasive parathyroidectomy

2015 ◽  
Vol 97 (6) ◽  
pp. 420-424 ◽  
Author(s):  
HZ Butt ◽  
MA Husainy ◽  
A Bolia ◽  
NJM London
Keyword(s):  
Parathyroid Hormone ◽  
Minimally Invasive ◽  
Minimally Invasive Parathyroidectomy ◽  
Invasive Parathyroidectomy ◽  
Preoperative Marking ◽  
Multiple Imaging ◽  
Parathyroid Tumour ◽  
Parathyroid Hormone Assay ◽  
Parathyroid Tumours ◽  
Intraoperative Parathyroid Hormone

Introduction Minimally invasive parathyroidectomy (MIP) is performed via a short incision (≤3cm). Previous studies have employed multiple imaging modalities including ultrasonography, sestamibi imaging and/or intraoperative parathyroid hormone assay. We present our eight-year experience of MIP using ultrasonography alone. Methods One hundred parathyroidectomies performed by a single surgeon between April 2004 and December 2012 were identified in a prospectively maintained database. All patients underwent ultrasonography including preoperative marking of the lesion by a single radiologist. No other localising diagnostic tests were performed. Results Of the 100 patients (69% female) who underwent parathyroidectomy, 93 had MIP. The median age of all cases was 58 years (range: 19–90 years). All patients exhibited an elevated parathyroid hormone level (median: 19pmol) in the presence of hypercalcaemia (median: 2.86mmol/l, range: 2.54–3.94mmol/l). Conventional surgery was indicated in seven patients owing to the need for concurrent thyroidectomy. The median operative time was 30 minutes (range: 10–130 minutes). Ultrasonography localised parathyroid tumour position correctly in 98% of patients who underwent MIP, and in 97% across both MIP and non-MIP groups. Postoperative complications requiring treatment included pancreatitis and symptomatic hypocalcaemia. Follow-up review at 6–8 weeks demonstrated that 86% of open cases (6/7) and 94% of MIP cases (87/93) were rendered normocalcaemic. Conclusions Our study is the first to demonstrate that the sole use of ultrasonography including preoperative marking can localise parathyroid tumours correctly in 98% of cases suitable for MIP.

scholarly journals The use of intraoperative parathyroid hormone monitoring in minimally invasive parathyroid surgery

2016 ◽  
Vol 98 (7) ◽  
pp. 516-519 ◽  
Author(s):  
J Helbrow ◽  
AE Owais ◽  
AG Sidwell ◽  
LM Frank ◽  
ME Lucarotti
Keyword(s):  
Parathyroid Hormone ◽  
Minimally Invasive ◽  
Operating Time ◽  
Minimally Invasive Parathyroidectomy ◽  
Parathyroid Surgery ◽  
First Line ◽  
Invasive Parathyroidectomy ◽  
Parathyroid Hormone Monitoring ◽  
Intraoperative Parathyroid Hormone ◽  
Iopth Measurement

Introduction Surgery is the first-line management option for patients with primary hyperparathyroidism (pHPT). Minimally invasive parathyroidectomy (MIP) is now preferable but few centres offer this service, mainly because of lack of intraoperative parathyroid hormone (IOPTH) testing. The aim of this study was to identify whether the measurement of IOPTH in patients having minimally invasive parathyroidectomy for pHPT alters their management. Methods A retrospective review was carried out of 78 consecutive patients who underwent parathyroid surgery by a single surgeon with a special interest in parathyroid surgery. The clinical impact of IOPTH monitoring was recorded postoperatively in a timely manner. Serum adjusted calcium levels were checked preoperatively (on admission) and one month postoperatively; normalisation was considered a cure. Results In the setting of curative MIP, IOPTH measurement did not influence the management in any of the patients but it could have led to bilateral parathyroid exploration (BPE) in three instances. Similarly, in cases that required lengthening of the MIP incision, IOPTH results did not influence patient management although it could have led to BPE in one case. Conclusion MIP offers an effective cure for patients with hyperparathyroidism. The addition of IOPTH testing adds increased expense, operating time and risk to patients otherwise suitable for MIP.

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