Nuclear mapping in parathyroidectomy: the impact on operative time

Precise intraoperative localization and identification of hyperactive parathyroid tissue remains one of the most challenging tasks for surgeons performing parathyroidectomies. Among a few adjuvant methods tested recently, a novel technique called nuclear mapping may become a real breakthrough in parathyroid surgery. It is based on intraoperative detection of radioactivity after previous intravenous administration of 99mTc Sestamibi, which is accumulated in hyperactive parathyroid tissue. The purpose of this study was to assess the impact of nuclear mapping on operative time in parathyroidectomy.

The study was conducted as a retrospective univariable and multivariable analysis of clinical factors potentially influencing the operative time in a group of 27 patients undergoing parathyroidectomy.

Univariable analysis revealed that nuclear mapping was associated with significant reduction in operative time (79.4 +/- 62.2 min vs. 135.8 +/- 49.2 min; p = 0.0186); whereas, bilateral neck exploration, partial sternotomy and reoperative neck prolonged the procedure by mean 70.7 +/- 12.9 min (p = 0.0035); 100,9 +/- 50.36 min (p = 0.0154) and 73.3 +/- 22.8 min (p = 0.0081), respectively. Multivariable analysis using a multiple regression model identified nuclear mapping, sternotomy and reoperative neck as independent variables significantly influencing the duration of parathyroidectomy.

Nuclear mapping is an efficient intraoperative adjuvant technique facilitating localization of hyperactive parathyroid tissues in vivo and instantly confirming their identity ex vivo. It guides the surgeon throughout the parathyroidectomy and is associated with significant reduction in operative time.