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Arch Surg. 2002 Aug;137(8):967-70.

Radioguidance is not necessary during parathyroidectomy.

Author information

  • 1Department of Surgery, Mount Sinai School of Medicine, New York, NY, USA. b.inabnet@mountsinai.org

Abstract

BACKGROUND:

Improvements in the accuracy of preoperative localization and the availability of the rapid parathyroid hormone assay have permitted minimally invasive parathyroidectomy in patients with primary hyperparathyoidism.

HYPOTHESIS:

The use of intraoperative radioguidance is beneficial during targeted parathyroid operations.

DESIGN:

A retrospective analysis of a prospective database of patients.

SETTING:

Tertiary care referral center.

PATIENTS:

During a 2(1/2)-year period, 130 patients underwent minimally invasive, targeted parathyroidectomy with intraoperative monitoring of the parathyroid hormone level. Of these, 60 patients underwent radioguided parathyroidectomy. Prior to surgery, a solitary parathyroid adenoma was visualized on technetium Tc 99m sestamibi scintigraphy in all patients selected for radioguided parathyroidectomy. A gamma probe was used to guide the surgical dissection.

RESULTS:

All patients were cured following radioguided parathyroidectomy. In 29 patients (48%), the probe provided confusing or inaccurate information; however, a unilateral neck exploration with excision of a parathyroid adenoma was successfully completed in each of these patients. Forty-three cases were completed under local anesthesia and 85% were discharged home on the same day of surgery. There was 1 temporary recurrent laryngeal nerve palsy.

CONCLUSION:

In the era of improved preoperative localization and intraoperative parathyroid hormone monitoring, the routine use of radioguidance is not recommended during parathyroidectomy.

PMID:
12147000
[PubMed - indexed for MEDLINE]
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