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Radioguidance is not necessary during parathyroidectomy
William B Inabnet1, Chun K Kim, Richard S Haber
1Department of Surgery, Mount Sinai School of Medicine, New York, NY, USA. b.inabnet@mountsinai.org
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.