Minimally invasive radioguided parathyroidectomy for hyperparathyroidism

Clinical or subclinical hyperparathyroidism (HPT) is one of the most common endocrine disorders. In patients with HPT who meet the indications for parathyroidectomy, complete surgical resection of all hyperfunctioning parathyroid tissue is essential for the curative treatment. The conventional surgical approach is bilateral neck exploration, whereas minimally invasive parathyroidectomy has been made possible by the introduction of Tc-99m-sestamibi scintigraphy for preoperative localization of parathyroid adenomas. In minimally invasive surgery, the surgeon expects some modalities that predict complete resection of all hyperfunctioning parathyroid glands. The prevalence rate of Tc-99m-sestamibi scanning for single parathyroid adenoma was widely accepted as 85-95%. Moreover, the recent developing technology of semiconductor electronics has produced useful portable gamma-probes. Intraoperative navigation using these devices provides the possibility of easy and definitive identification of parathyroid nodules during the operation. In minimally invasive radioguided parathyroidectomy using gamma-probe, different protocols are based on different timing and doses of tracer injected. Each procedure is technically easy, safe, with a low morbidity rate, and has better cosmetic results and lower overall cost than conventional bilateral neck exploration. We have applied this technique in selected patients and achieved success comparable to that achieved with contemporaneously performed standard neck exploration. In the hands of a competent surgeon, the use of sestamibi scanning and radioguided parathyroidectomy in appropriately selected patients is a useful technique.