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.
Keywords:
Primary hyperparathyroidism, minimally invasive parathyroidectomy, intraoperative parathyroid hormone assays
References
1
Silverberg SJ, Shane E, Jacobs TP et al. A 10-year prospective study of primary hyperparathyroidism with or without parathyroid surgery. N Engl J Med 1999;341:1249-1255.
2
Burney RE, Jones KR, Coon JW et al. Assessment of patient outcomes after operation for primary hyperparathyroidism. Surgery 1996;120:1013-1018.
3
Sheldon DG, Lee FT, Neil NJ, et al. Surgical treatment of Hyperparathyroidism improves health-related quality of life. Arch Surg 2002;137:1022-1026.
4
Roman SA, Sosa JA, Mayes L et al. Parathyroidectomy improves neurocognitive deficits in patients with primary hyperparathyroidism. Surgery 2005;138:1121-1128.
5
Coker LH, Rorie K, Cantley L et al. Primary hyperparathyroidism, cognition, and health-related quality of life. Ann Surg 2005;242:642-650.
6
Sackett WR, Barraclough B, Reeve TS et al. Worldwide trends in the surgical treatment of primary hyperparathyroidism in the era of minimally invasive parathyroidectomy. Arch Surg 2002;137:1055-1059.
7
Udelsman R. Six hundred fifty-six consecutive explorations for primary hyperparathyroidism. Ann Surg 2002;235:665-670.
8
Bergenfelz A, Lindblom P, Tibblin S et al. Unilateral versus bilateral neck exploration for primary hyperparathyroidism: a prospective randomized controlled trial. Ann Surg 2002;236:543-551.
9
Vignali E, Picone A, Materazzi G et al. A quick intraoperative parathyroid hormone assay in the surgical management of patients with primary hyperparathyroidism: a study of 206 consecutive cases. Eur J Endocrinol 2002;146:783-788.
10
Proctor MD, Sofferman RA. Intraoperative parathyroid hormone testing: what have we learned? Laryngoscope 2003;113:706-714.
11
Burkey SH, Van Heerden JA, Farley DR et al. Will directed parathyroidectomy utilizing the gamma probe or intraoperative parathyroid hormone assay replace bilateral cervical exploration as the preferred operation for primary hyperparathyroidism? World J Surg 2002; 26:914-920.
12
Denham DW, Norman J. Cost-effectiveness of preoperative sestamibi scan for primary hyperparathyroidism is dependent solely upon the surgeon's choice of operative procedure. J Am Coll Surg 1998;186:293-305.
13
Norman J, Chheda H. Minimally invasive parathyroidectomy facilitated by intraoperative nuclear Surgery 1997;122:998-1003.
14
Murphy C, Norman J. The 20% rule: a simple, instantaneous radioactivity measurement defines cure and allows elimination of frozen sections and hormone assays during parathyroidectomy. Surgery 1999;126:1023-1028.
15
Norman J, Denham D. Minimally invasive radioguided parathyroidectomy in the reoperative neck. Surgery 1998;124:1088-1092.
16
Irvin GL 3rd, Dembrow VD, Prudhomme DL. Operative monitoring of parathyroid gland hyperfunction. Am J Surg 1991;162:299-302.
17
Irvin GL 3rd, Prudhomme DL, Deriso GT et al. A new approach to parathyroidectomy. Ann Surg 1994;219:574-579.
18
Carty SE, Worsey J, Virji MA et al. Concise parathyroidectomy: the impact of preoperative SPECT 99mTc sestamibi scanning and intraoperative quick parathormone assay. Surgery 1997;122:1107-1114.
19
Irvin GL 3rd, Sfakianakis G, Yeung L et al. Ambulatory parathyroidectomy for primary hyperparathyroidism. Arch Surg 1996;131:1074-1078.
20
Shabtai M, Ben-Haim M, Muntz Y et al. 140 consecutive cases of minimally invasive, radio-guided parathyroidectomy: lessons learned and long-term results. Surg Endosc 2003;17:688-691.
21
Goldstein RE, Billheimer D, Martin WH et al. Sestamibi scanning and minimally invasive radioguided parathyroidectomy without intraoperative parathyroid hormone measurement. Ann Surg 2003;237:722-730.
22
Ollila DW, Caudle AS, Cance WG et al. Successful minimally invasive parathyroidectomy for primary hyperparathyroidism without using intraoperative parathyroid hormone assays. Am J Surg 2006;191:52-56.
23
Fahy BN, Bold RJ, Beckett L et al. Modern parathyroid surgery: a cost-benefit analysis of localizing strategies. Arch Surg 2002;137:917-922.
24
Levin KE, Clark OH. The reasons for failure in parathyroid operations. Arch Surg 1989;124:911-914.
25
Garner SC, Leight GS Jr. Initial experience with intraoperative PTH determinations in the surgical management of 130 consecutive cases of primary hyperparathyroidism. Surgery 1999 Dec;126:1132-1137.
26
Gordon LL, Snyder WH 3rd et al. The validity of quick intraoperative parathyroid hormone assay: an evaluation in seventy-two patients based on gross morphologic criteria.Surgery 1999;126:1030-1035.
27
Krausz Y, Lebensart PD, Klein M et al. Preoperative localization of parathyroid adenoma in patients with concomitant thyroid nodular disease. World J Surg 2000;24:1573-1578.
28
Sianesi M, Del Rio P, Arcuri MF et al. Hyperparathyroidism associated with thyroid pathology. Am J Surg 2003;185:58-60.
29
Beus KS, Stack BC Jr. Synchronous thyroid pathology in patients presenting with primary hyperparathyroidism. Am J Otolaryngol 2004;25:308-312.
30
Lumachi F, Marzola MC, Zucchetta P et al. Hyperfunctioning parathyroid tumours in patients with thyroid nodules. Sensitivity and positive predictive value of high-resolution ultrasonography and 99mTc-sestamibi scintigraphy. Endocr Relat Cancer 2003;10:419-423.
31
Mehta NY, Ruda JM, Kapadia S et al. Relationship of technetium Tc 99m sestamibi scans to histopathological features of hyperfunctioning parathyroid tissue. Arch Otolaryngol Head Neck Surg 2005;131:493-498.
32
Erbil Y, Barbaros U, Yanik BT. Impact of gland morphology and concomitant thyroid nodules on preoperative localization of parathyroid adenomas. Laryngoscope 2006;116:580-585.
