Minimally invasive radioguided parathyroidectomy

Abstract

In the last years, with the aim of reducing operative time and having better cosmetic results, minimally-invasive parathyroidectomy (MIP) has become to be extensively performed. Several techniques are available, including videoendoscopic techniques, and radioguided parathyroidectomy.

In patients undergoing radio-guided parathyroidectomy receive an intravenous injection of 99mTc-sestamibi 60-90 minutes before the operation was scheduled to start. Four early images are obtained 5 minutes after radiopharma ceutical administration, with the aim of confirming the side and site of the enlarged PT gland. Intraoperative nuclear mapping using a hand-held gamma probe and quantitati ve gamma camera counting in the four quadrants is obtai ned. A 2-3 cm incision is made, and the enlarged PT gland excision is guided by the probe, resulting in a decli ne in radioactivity in the corresponding quadrant. Intraoperative quick PTH is routinely assayed. When the PTH levels at 10 min fail to fall to less than 50% of the preo perative levels, a multiglandular disease should be suspec ted and a bilateral neck exploration is usually required. MIP is a safe, cost-effective alternative to bilateral explo ration, and should be considered the procedure of choice in patients with primary HPT, when preoperative imaging tests have suggested the presence of a PT adenoma. Radioguided MIP may improve the success rate of surgery in patients with primary hyperparathyroidism