The Technique of Intraoperative Nuclear Mapping to Facilitate Minimally Invasive Parathyroidectomy

Background Despite the fact that primary hyperparathyroidism (HPTH) is the result of a single adenoma in 85% to 92% of cases and is cured following the removal of this one gland, many surgeons continue to perform a complete bilateral neck exploration for patients with primary HPTH. The advent of the sestamibi scan now enables the identification of patients with a single adenoma. Methods The use of preoperative sestamibi scanning followed immediately by minimally invasive parathyroidectomy using intraoperative nuclear mapping allows cure for primary HPTH in properly selected patients. Results Reports have shown that preoperative sestamibi scanning has a sensitivity of approximately 90% and a specificity of almost 100% in identifying patients with a single adenoma. Intraoperative mapping allows a limited dissection to be performed under local anesthesia in an outpatient setting in approximately 80% of all patients with primary hyperparathyroidism. The details of this new technique — patient selection, timing, use of the intraoperative nuclear probe, and surgical exploration — are described. Conclusions When selected appropriately, most patients with primary HPTH can be successfully treated through a minimally invasive technique.