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Invasive Parathyroidectomy (invasive + parathyroidectomy)

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Medical Sciences	100%

Selected Abstracts

MINIMALLY INVASIVE PARATHYROIDECTOMY USING SURGEON-PERFORMED ULTRASOUND AND SESTAMIBI

ANZ JOURNAL OF SURGERY, Issue 9 2007
Subhita Prasannan
Background: Surgeon-performed ultrasound (SPU) and 99mTc-sestamibi (SM) scanning can be used alone or in combination in patients with primary hyperparathyroidism to select cases suitable for minimally invasive parathyroidectomy (MIP). The aim of the study was to evaluate SPU and SM and to determine the reliability they provide the surgeon in planning and carrying out MIP. Methods: The study was a prospective analysis of 130 patients with primary hyperparathyroidism who had preoperative localization with SPU and SM at a tertiary referral centre between 2003 and 2006. All ultrasound scans were carried out by one surgeon, followed by correlative sestamibi scan and a further ,on operating table' ultrasound to reassess the lesion and mark the operative site. Selection criteria for MIP were a positive SPU and SM, although a positive SPU or SM allowed the surgeon to focus on the nominated side. SPU and SM localizations were correlated to the operative findings. Results: One hundred and thirty patients underwent both SPU and SM. There were 97 women and 33 men, with a mean age of 59 years. SPU alone identified the abnormal parathyroid in 103 cases (sensitivity 82%; positive predictive value 96.3%). SM alone identified the abnormal gland in 102 cases (sensitivity 79%; positive predictive value 99%). In 88 patients, the SPU and SM were concordant, and 94% had successful MIP. SPU and SM were both negative in 13 patients, and all these patients had bilateral neck exploration. Conclusion: SPU in the hands of an experienced surgeon in association with sestamibi is a reliable tool for the preoperative localization of parathyroid adenomas and facilitates a minimally invasive procedure. [source]

Cytopathologist-performed ultrasound-guided fine-needle aspiration of parathyroid lesions,

DIAGNOSTIC CYTOPATHOLOGY, Issue 5 2010
David Lieu M.D., M.B.A.
Abstract The gold standard to determine the cause of primary hyperparathyroidism (PHPT) is bilateral neck exploration. As most cases are caused by parathyroid adenoma, there is a movement toward preoperative localization of the abnormal gland by ultrasound and/or Tc99 -sestamibi scan and minimally invasive parathyroidectomy. Nonpalpable thyroid nodules are common and cannot be differentiated from parathyroid lesions by imaging alone. This study examines cytopathologist-performed ultrasound-guided fine-needle aspiration (UG-FNA) in diagnosis of parathyroid lesions. Between January 1, 2007 and December 31, 2008, seven patients with PHPT or other parathyroid lesions with one or more sonographically-visible thyroid masses underwent cytopathologist-performed UG-FNA with immediate cytological evaluation (ICE). One mass was palpable and nine were nonpalpable. Three parathyroid adenomas, two benign colloid nodules, one papillary carcinoma, three parathyroid cysts, and one thyroid cyst were diagnosed. The nodules in three patients with parathyroid adenomas were identified as follicular lesion/neoplasm on ICE. Additional UG-FNA passes were made to obtain tissue for immunohistochemistry stains, which confirmed parathyroid origin. Two of these patients had a separate benign colloid nodule and one had a thyroid cyst diagnosed by UG-FNA. The PHPT patient with papillary carcinoma on UG-FNA had the malignancy confirmed at surgery and a sonographically occult parathyroid adenoma. The three patients with thyroid cysts identified by radiology were suspected of being parathyroid cysts on the basis of real-time sonographic features at the biopsy table. The clear cyst fluid obtained by UG-FNA had markedly elevated PTH. Cytopathologist-performed UG-FNA can distinguish between parathyroid and thyroid nodules in patients with suspected parathyroid lesions. Diagn. Cytopathol. 2010. © 2009 Wiley-Liss, Inc. [source]

Correlation of Intraoperative Parathyroid Hormone Levels With Parathyroid Gland Size,

THE LARYNGOSCOPE, Issue 11 2007
William H. Moretz III MD
Abstract Objectives: To study the relationship of intraoperative intact parathyroid hormone levels (iPTH) with parathyroid adenoma weight and volume in patients with primary hyperparathyroidism. Methods: Retrospective evaluation of consecutive patients undergoing minimally invasive parathyroidectomy with iPTH measurement. Data collected include preoperative serum calcium, ionized calcium, and serum parathyroid hormone (PTH) levels, iPTH levels at baseline, 5 minutes, and 10 minutes, and parathyroid adenoma weight. Adenoma volume was calculated using an equation for the volume of a spheroid object. Results: Thirty patients underwent minimally invasive parathyroidectomy with iPTH measurement for a single parathyroid adenoma between March 2004 and January 2006. There were 8 men and 22 women, with a mean age of 59.3 (range 26,92) years. A significant correlation between preoperative serum calcium and ionized calcium levels and parathyroid adenoma weight was identified (P = .0008 and P = .03, respectively). A significant correlation was also shown between baseline iPTH measurements and parathyroid adenoma volume (P = .03). There was no correlation between baseline iPTH levels and parathyroid adenoma weight. There was a significant correlation between parathyroid adenoma weight and percentage decrease of iPTH levels at 10 minutes compared to baseline (P = .04). Conclusion: Preoperative serum calcium and baseline iPTH levels may be useful in predicting parathyroid adenoma weight and volume, respectively. Adenoma weight may relate to the percentage decrease of iPTH levels at the 10-minute postparathyroidectomy interval. [source]

MINIMALLY INVASIVE PARATHYROIDECTOMY USING SURGEON-PERFORMED ULTRASOUND AND SESTAMIBI

Development of a parathyroid database in Melbourne and review of the last 50 cases

ANZ JOURNAL OF SURGERY, Issue 9 2004
Meei J. Yeung
Background: Minimally invasive parathyroidectomy (MIP) is only possible if preoperative localization studies accurately identify the abnormal parathyroid tissue. The aim of the present paper was to evaluate the accuracy of these studies in our geographical region and the consequences on MIP. Methods: A Filemaker Pro database was designed and a retrospective analysis was carried out on the last 50 parathyroidectomies. Results: There were a total of 49 patients who underwent parathyroidectomy; with one patient having two operations. Forty-nine preoperative ultrasound localization studies were performed. Ultrasound sensitivity of correct localization of abnormal parathyroids was 41% with a false positive rate of 25%. Twenty-two sestamibi scans identified 14 abnormal parathyroids. Sestamibi scanning had a sensitivity of 32% for correct localization and a false positive rate of 32%. There were 16 different radiologists or nuclear medicine physicians involved with the nuclear medicine scans, and 22 different radiologists involved in the preoperative ultrasound scans. Forty-seven patients were cured of hyperparathyroidism after a primary operation, with a total of 48 patients in all being cured following re-exploration. One patient was lost to follow up. The success of primary exploration was therefore 96% and following re-exploration this increased to 98%. Conclusion: We found preoperative localization studies to have low sensitivities and high false positive rates. To move successfully towards MIP, we need to identify a radiologist with a special interest in localization studies to achieve greater accuracy. [source]

Minimally invasive parathyroidectomy for recurrent or persistent hyperparathyroidism using carbon track localization

ANZ JOURNAL OF SURGERY, Issue 10 2003
Robert J. Kennedy
Background: The present study documents the use of carbon tracking to localize parathyroid adenomas in three patients with persistent or recurrent parathyroid disease. Methods: Three patients requiring second or third operations for hyperparathyroidism were operated upon after the parathyroid lesion had been localized preoperatively using a suspension of carbon particles in water. The enlarged parathyroid glands were identified by using one or more of the following: computed axial tomography, magnetic resonance imaging, ultrasound or Sestamibi nuclear scan. The lesion was then localized with ultrasound or computed axial tomography and a carbon track was inserted from the lesion to the skin, leaving a small skin tattoo as a marker for the surgeon. Each patient underwent a minimally invasive parathyroid operation. Results: For each of the three patients the recurrent or persistent parathyroid adenoma was successfully identified and removed via a small incision. Conclusion: Minimally invasive techniques for primary hyperparathyroidism are changing our approach to parathyroid surgery. However, a minimally invasive technique is less applicable when the disease is persistent or recurrent. Although, when the recurrent or persistent parathyroid adenoma can be identified, localization and carbon tracking have proved useful in allowing the surgeon to remove the lesion via a minimally invasive technique. [source]

Minimally invasive parathyroidectomy without intraoperative parathyroid hormone monitoring in patients with primary hyperparathyroidism

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 1 2007
R. Mihai
Background: Minimally invasive parathyroidectomy (MIP) is the preferred operation for patients with primary hyperparathyroidism (HPT) and positive preoperative imaging. This non-randomized case series assessed the long-term results of MIP performed without the use of intraoperative parathyroid hormone (ioPTH) monitoring. Methods: The study involved prospective collection of demographic, biochemical and operative details on a consecutive, unselected cohort of 298 patients who underwent surgery for non-familial primary HPT during a 5-year interval. The mean preoperative serum calcium level was 3·00 mmol/l with a mean parathyroid hormone concentration of 25·8 pmol/l. 99mTc-labelled sestamibi scanning and neck ultrasonography were performed in 262 patients. Results: Sestamibi scan showed unilateral uptake in 182 patients and a single parathyroid adenoma was confirmed on ultrasonography in 161 patients. MIP was performed in 150 patients. The mean duration of operation was 25 (range 8,65) min. Four patients needed conversion to conventional neck exploration. There was one postoperative haematoma and three cases of temporary recurrent laryngeal nerve neuropraxia. All but four patients were normocalcaemic after MIP. All the parathyroid tumours removed were adenomas, with a mean weight of 1·3 (range 0·1,17·4) g. No patient developed recurrent HPT after a median follow-up of 16 (range 3,48) months. Conclusion: The outcome of MIP without ioPTH monitoring was comparable to that reported in series that used ioPTH monitoring. Copyright © 2006 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]