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Transoral Robotic Total Thyroidectomy and Bilateral Central Regional Lymph Node Dissection for Papillary Thyroid Carcinoma
Published on: September 15, 2023
Minimally invasive radio-guided surgery for primary hyperparathyroidism
Brian R Untch1, Michael E Barfield, Joe Bason
1Department of Surgery, Duke University Medical Center, Box 3873, Durham, NC 27710, USA.
Annals of Surgical Oncology
|September 28, 2007
Summary
Radio-guided minimally invasive parathyroidectomy using Tc-99 Sestamibi is effective for hyperparathyroidism. This technique offers a successful approach for parathyroid adenoma localization and removal, reducing patient morbidity.
Area of Science:
- Endocrinology
- Nuclear Medicine
- Surgical Oncology
Background:
- Minimally invasive parathyroidectomy reduces operative morbidity and time.
- Radio-guided surgery using Tc-99m Sestamibi is a minimally invasive approach.
- This study presents a multimedia case of radio-guided minimally invasive parathyroidectomy.
Observation:
- A 60-year-old female presented with hypercalcemia (11.1 mg/dl) and elevated intact parathyroid hormone (iPTH) (175 pg/ml).
- Tc-99 Sestamibi scan and ultrasound localized a parathyroid adenoma to the right upper position.
- The patient received Tc-99m Sestamibi 3 hours prior to surgery.
Findings:
- Intraoperative gamma probe detected 160% above background counts at the adenoma site.
- A 1.4-g adenoma was resected, with ex vivo counts 150% above background.
- Post-resection iPTH levels dropped by 90% (to 17-18 pg/ml) within 10 minutes.
- One-year follow-up showed normalized calcium (8.7 mg/dl) and iPTH (53 pg/ml) levels.
Implications:
- Radio-guided minimally invasive parathyroidectomy with Tc-99 Sestamibi is effective for hyperparathyroidism.
- For cases lacking localization, exposing all four parathyroid glands is recommended.
- Surgeons should be proficient in both radio-guided and traditional parathyroidectomy techniques.
