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Minimally Invasive, Radioguided Surgery for Primary Hyperparathyroidism

From the Academic Department of Surgery and Department of Surgical Oncology, National University of Ireland, Cork, at Cork University Hospital, and Mercy Hospital, Cork, Ireland.

Correspondence: Address correspondence and reprint requests to: Professor H. P. Redmond, MCh, FRCSI, Academic Department of Surgery, Cork University Hospital, Wilton, Cork, Ireland; Fax: 353-21-343307; E-mail: p.redmond{at}ucc.ie

Background: Primary hyperparathyroidism affects 1 in 700 individuals in the United States. A single adenoma is responsible in over 85% of cases. Surgery remains the most effective treatment. This study was designed to assess the feasibility of minimally invasive radioguided parathyroidectomy (MIRP) with confirmation of excision by ex vivo radioactivity alone.

Methods: Seventy-five consecutive patients with primary hyperparathyroidism were prospectively studied. Following sestamibi scan, patients underwent unilateral neck exploration guided by a handheld gamma probe, which was also used to measure ex vivo radioactivity of excised tissue.

Results: The sestamibi scan was positive in 88% of the patients. A small incision (mean, 3.2 ± 0.3 cm) was sufficient. Ectopic gland sites were localized in five patients with positive scans and single adenomas. Mean operative time was 48 minutes (range, 15–125 minutes), with shorter procedures after the initial 20 cases (mean, 24 vs. 72 minutes; P < .01). Radioguided parathyroidectomy was successful in 97%, with a mean follow-up of 11 months (range, 1–26 months). As noted previously, adenomatous parathyroid glands contained more than 20% of the background radioactivity.

Conclusions: MIRP is a feasible alternative to bilateral dissection with the advantages of guided dissection and rapid confirmation, and may become the procedure of choice for primary hyperparathyroidism.

Key Words: Hyperparathyroidism • Minimally invasive parathyroidectomy • Sestamibi

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