scholarly journals Feasibility of Intraoperative Parathyroid Hormone Monitoring in Minimally Invasive Surgery

2021 ◽  
Vol 64 (7) ◽  
pp. 491-499
Author(s):  
Soo Jin Kim ◽  
Ju Hyun Yun ◽  
Sohl Park ◽  
Yu Jin Go ◽  
So Jeong Lee ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Normal Limit ◽  
Multiglandular Disease ◽  
Parathyroid Hormone Monitoring ◽  
Pet Ct ◽  
Sestamibi Scan ◽  
Abnormal Parathyroid Gland ◽  
Intraoperative Parathyroid Hormone ◽  
New Criteria ◽  
Single Lesion

Background and Objectives There has been a long debate on whether intraoperative parathyroid hormone (IOPTH) monitoring is mandatory or not in the excision of a single abnormal parathyroid gland. The aim of this study is to suggest a new criteron of IOPTH monitoring. Subjects and Method We retrospectively analyzed 31 patients who underwent parathyroidectomy from 2005 to 2019. Patients had IOPTH not measured and those with secondary hyperparathyroidism were excluded. IOPTH was measured preoperatively (EX00), at 10 minutes (EX10) and 20 minutes (EX20) after the excision and analyzed. We determined the surgery as a ‘successful excision of lesion (SEOUL)’ when it met the following criteria: criterion 1) the level of EX10 or EX20 decreased under the upper normal or under upper limit of parathyroid hormone (65 pg/mL); criterion 2) EX20 decreased below 50% of EX00 and less than 195 pg/ mL (3 times the upper normal limit); criterion 3) multiglandular disease. Results Twenty-five patients among 31 patients were included this study (M:F=8:17). Twenty- two patients were suspected of single lesion and three patients of multiple lesions on preoperative images (99mTc-sestamibi scan, neck CT, and PET-CT). IOPTH of EX00, EX10, and EX20 were 488.92±658.74, 121.36±134.73, and 92.44±111.55 pg/mL, respectively. Sixty-four percent patients (16/25) met the criterion 1. Six patients (24%) successfully excised a lesion meeting the criterion 2. Three patients had multiglandular disease, meeting the criterion 3. Conclusion Our new criteria suggest when we could stop the procedure. If the level of IOPTH does not meet the SEOUL criteria, it means that there might be more lesions.

Diminished Dose Minimally Invasive Radioguided Parathyroidectomy: A Case for Radioguidance

2007 ◽  
Vol 73 (7) ◽  
pp. 669-672 ◽  
Author(s):  
Christopher J. You ◽  
John L. Zapas
Keyword(s):  
Parathyroid Hormone ◽  
Minimally Invasive ◽  
Frozen Section ◽  
Standard Dose ◽  
Intraoperative Mapping ◽  
Parathyroid Hormone Monitoring ◽  
Frozen Section Analysis ◽  
Radioguided Parathyroidectomy ◽  
Intraoperative Parathyroid Hormone ◽  
Section Analysis

Minimally invasive radioguided parathyroidectomy (MIRP) has been established as an alternative to bilateral neck exploration (BNE) for primary hyperparathyroidism. We investigate whether a diminished dose of technetium-99m sestamibi gives similar results to the standard dose. One hundred one patients were offered MIRP or diminished-dose MIRP (ddMIRP). Patients received intravenous Tc-99m sestamibi at a dose of either 25 mCi 1.5 hours or 5 mCi 1 hour preoperatively. The procedure was terminated when the 20 per cent rule was satisfied. All tissue was confirmed to be parathyroid tissue by frozen section analysis. In addition, intraoperative parathyroid hormone levels were measured in a majority of patients. Patients who failed IOM underwent BNE. Frozen section analysis and intraoperative parathyroid hormone monitoring were also performed in the BNEs. Postoperatively, serum calcium levels were measured at 1 week and 6 months. Fifteen per cent of patients were male and 85 per cent were female. The median age was 63 years (range, 25–89 years). The first 58 patients had the standard dose of 25 mCi, whereas 43 patients had ddMIRP. Six patients (10%) failed intraoperative mapping in the MIRP group and were found to have single-gland disease. Five patients (12%) failed intraoperative mapping in the ddMIRP group. However, two patients were identified to have multigland disease making the true failure rate of intraoperative mapping 7 per cent (three patients). Median operative times for MIRP, ddMIRP, and BNE were 40 minutes, 46 minutes, and 105 minutes, respectively. The 20 per cent rule was satisfied in 96 per cent of patients undergoing MIRP and 98 per cent of patients undergoing ddMIRP. Frozen section analysis and intraoperative parathyroid hormone monitoring did not result in a change in management. Median follow up was 193 days and serum calcium levels at 6 months were normal. Diminished-dose MIRP is a feasible alternative to standard-dose MIRP without compromising surgical outcomes.

Minimally Invasive Parathyroid Surgery, The Norman 20% Rule: Is It Valid?

2011 ◽  
Vol 77 (4) ◽  
pp. 484-487 ◽  
Author(s):  
Amy R. Quillo ◽  
Jeffery M. Bumpous ◽  
Richard E. Goldstein ◽  
Muffin M. Fleming ◽  
Ccrp ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
Minimally Invasive ◽  
Parathyroid Gland ◽  
Ex Vivo ◽  
Frozen Section ◽  
Postoperative Management ◽  
Average Percentage ◽  
Parathyroid Hormone Monitoring ◽  
Intraoperative Parathyroid Hormone

The 20 per cent rule proposed by Norman established a guideline using radioactivity in the minimally invasive radioguided parathyroidectomy (MIRP) technique to localize and confirm removal of an abnormal parathyroid gland in patients with primary hyperparathyroidism. If radioactivity in the resected gland was at least 20 per cent of excision site/background radioactivity, the 20 per cent rule was satisfied. Patients meeting these criteria underwent unilateral MIRP without intraoperative parathyroid hormone assay or intraoperative frozen section. The study aim was to independently evaluate the 20 per cent rule in MIRP patients with primary hyperparathyroidism. Using the University of Louisville Parathyroid Database from January 1, 1999 to December 31, 2007, 216 MIRP patients with complete radioguided and postoperative management data were identified. The average percentage of ex vivo parathyroid gland radioactivity compared with excision site/background radioactivity was 107 per cent with a range from 14 to 388 per cent. For 99 per cent (196/198) radioactivity recorded from the excised gland was at least 20 per cent of radioactivity recorded from the excision site. Normocalcemia was documented in 98.5 per cent (195/198) at 12 month follow-up. Our data supports the 20 per cent rule in that in 99 per cent of MIRP patients the resected gland radioactivity was at least 20 per cent of excision site radioactivity allowing localization and confirmation of an overactive gland without intraoperative parathyroid hormone monitoring or tissue analysis.

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