[Surgical treatment and localization techniques in primary hyperparathyroidism].

Area of Science:

• Endocrinology
• Surgical Oncology
• Radiology

Background:

• Primary hyperparathyroidism (PHPT) is definitively treated by parathyroidectomy.
• Bilateral neck exploration was the standard surgical approach.
• Technological advancements enable focused, minimally invasive parathyroidectomy.

Purpose of the Study:

• To review imaging techniques for preoperative localization in PHPT.
• To discuss the rationale behind these localization studies.
• To outline current minimally invasive surgical approaches.

Main Methods:

• Preoperative localization using (99m)TC-sestamibi scintigraphy (various protocols including SPECT).
• Complementary ultrasound for scintigraphy-negative or confirmatory cases.
• Advanced imaging (CT, MRI) for select cases where other methods fail.

Main Results:

• Accurate preoperative localization identifies patients with single-gland disease suitable for minimally invasive surgery.
• (99m)TC-sestamibi scintigraphy is a reliable diagnostic procedure.
• Minimally invasive techniques (mini-incision, endoscopic, video-assisted, radio-guided) achieve high success rates with optimized mapping.

Conclusions:

• Minimally invasive parathyroidectomy is a viable and effective treatment for PHPT.
• Preoperative imaging is crucial for selecting appropriate candidates and guiding surgical approach.
• Success rates of minimally invasive surgery match traditional bilateral exploration.