Success of minimally invasive single-gland exploration using the quick intraoperative parathyroid assay

Using accurate localization techniques and the quick intra-operative parathyroid assay (QPTH), surgery for primary hyperparathyroidism due to a solitary adenoma has moved from the traditional wide bilateral neck exploration to more limited approaches such as minimally invasive single-gland exploration (MISGE) and minimally invasive radio-guided parathyroidectomy (MIRP). This study investigated whether the MISGE could take the place of MIRP with the help of the QPTH.

From 2007 to 2009, 56 patients with primary hyperparathyroidism were studied. All patients were pre-operatively investigated by imaging techniques to improve the pre-operative determination of adenomas. Twenty-five patients were in the MIRP group and 31 in the MISGE group. QPTH was routinely measured; a 50% reduction in the QPTH level indicated complete excision.

There were no differences in the complication rates, surgical time, anaesthesia time or mean length of hospital stay between the groups. However, total hospital charges were more favourable in the MISGE group with a mean saving of $400 per case.

This study demonstrates that with the additon of the QPTH, MISGE can be performed as a quick and reliable procedure in correct adenoma removal instead of MIRP. Moreover MISGE achieves the optimal time interval between injection and exploration, reduces the radiation exposure of both patient and surgeon, decreases the cost, and decreases usage of pre-operative imaging and intra-operative equipment.