The Technique of Intraoperative Nuclear Mapping to Facilitate Minimally Invasive Parathyroidectomy

BACKGROUND: Despite the fact that primary hyperparathyroidism (HPTH) is the result of a single adenoma in 85% to 92% of cases and is cured following the removal of this one gland, many surgeons continue to perform a complete bilateral neck exploration for patients with primary HPTH. The advent of the sestamibi scan now enables the identification of patients with a single adenoma. METHODS: The use of preoperative sestamibi scanning followed immediately by minimally invasive parathyroidectomy using intraoperative nuclear mapping allows cure for primary HPTH in properly selected patients. RESULTS: Reports have shown that preoperative sestamibi scanning has a sensitivity of approximately 90% and a specificity of almost 100% in identifying patients with a single adenoma. Intraoperative mapping allows a limited dissection to be performed under local anesthesia in an outpatient setting in approximately 80% of all patients with primary hyperparathyroidism. The details of this new technique - patient selection, timing, use of the intraoperative nuclear probe, and surgical exploration - are described. CONCLUSIONS: When selected appropriately, most patients with primary HPTH can be successfully treated through a minimally invasive technique.