Minimally invasive parathyroidectomy results for primary hyperparathyroidism without using intraoperative parathyroid hormone assays

Abstract

Purpose: The need for introperative parathyroid hormone (iPTH) assays in minimally invasive parathyroidectomy (MİP) remains controversial, because of the high cost.

In this study, we have planned to evaluate the results of MİP without using the use of iPTH assays, in patients with primary hyperparathyroidism (PHPT).

Methods: Thirty-one patients with PHPT, who had pre-operative localization studies, including technetium -99m sestamibi scintigraphy (MIBI) and ultrasonography (US), and underwent radio-guided parathyroidectomy using introperative gama probe and frozen pathology examination between May 2004 and July 2007 were retrospectively reviewed,

Results: The mean pre-operative calcium and PTH levels were 10,3±0,9mg/dl (8,5-12 mg/dl) and 324±238 pg/ml (109-799 pg/ml), respectively. All patients had normal calcium and PTH levels in the post-operative 48th hour and 3rd month. The final pathology was reported as hypercellular parathyroid gland in all patients. The patients had a mean follow-up period of 17,1±9,9 (4-42) months and none of the patients developed recurrent hyperparathyroidism.

Conclusion: Using a combination of pre-operative MIBI, intra-operative gamma probe localization and frozen pathology, our success rate was %100 in MİP. We conclude that, MİP can be performed safely and successfully without using iPTH assays.