Advertisement

Annals of Surgical Oncology

, Volume 14, Issue 12, pp 3401–3402 | Cite as

Minimally Invasive Radio-guided Surgery for Primary Hyperparathyroidism

  • Brian R. Untch
  • Michael E. Barfield
  • Joe Bason
  • John A. OlsonJr.
Endocrine Tumors

Abstract

Background

Minimally invasive parathyroidectomy can reduce operative morbidity and operative time.1,2 Radio-guided parathyroidectomy utilizing Tc-99m Sestamibi is one approach to minimally invasive parathyroidectomy.3,4 Here, we report a multimedia case study of minimally invasive radio-guided parathyroidectomy.

Methods

A 60-year-old African American female was found to have total calcium of 11.1 mg/dl, intact parathyroid hormone (iPTH) of 175 pg/ml, and a 24-h urine calcium of 620 mg/24 h. A Tc-99 Sestamibi scan (23.5 mCi of Tc-99 Sestamibi injected i.v.) and ultrasound localized a candidate adenoma to the right upper position. The patient was injected with 5.3 mCi Tc-99m Sestamibi 3 h before incision.

Results

A gamma probe (C-Trak Automatic System, Care Wise Medical Products) recorded in vivo counts of the right upper parathyroid (3,465) that were 160% of the background. Background counts were recorded from the resected tumor bed (2,224). A 1.4-g adenoma was identified in this location; ex vivo counts (3,226) were 150% of the background.5 Intra-operative iPTH baseline values were 176 pg/ml and 148 pg/ml, and 5- and 10-min post-resection levels were 17 pg/ml (90% drop) and 18 pg/ml (90% drop), respectively. The patient’s recovery was uncomplicated. At 1 week postoperatively, total calcium was 8.9 mg/dl and iPTH was 16 pg/ml. At 1 year, the calcium and iPTH levels were 8.7 mg/dl and 53 pg/ml, respectively.

Conclusions

Radio-guided minimally invasive parathyroidectomy using Tc-99 Sestamibi localization is an effective approach to hyperparathyroidism. For patients without localization, exposure of all four parathyroid glands is preferable.6,7 Surgeons should be familiar with both techniques.

Keywords

Adenoma Hyperparathyroidism Parathyroid Gland Primary Hyperparathyroidism Parathyroid Adenoma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Supplementary material

Supplementary material

References

  1. 1.
    Goldstein RE, Blevins L, Delbeke D, Martin WH. Effect of minimally invasive radioguided parathyroidectomy on efficacy, length of stay, and costs in the management of primary hyperparathyroidism. Ann Surg 2000; 231:732–42PubMedCrossRefGoogle Scholar
  2. 2.
    Flynn MB, Bumpous JM, Schill K, McMasters KM. Minimally invasive radioguided parathyroidectomy. J Am Coll Surg 2000; 191:24–31PubMedCrossRefGoogle Scholar
  3. 3.
    Nichol PF, Mack E, Bianco J, Hayman A, Starling JR, Chen H. Radioguided parathyroidectomy in patients with secondary and tertiary hyperparathyroidism. Surgery 2003; 134:713–17PubMedCrossRefGoogle Scholar
  4. 4.
    Chen H, Mack E, Starling JR. Radioguided parathyroidectomy is equally effective for both adenomatous and hyperplastic glands. Ann Surg 2003; 238:332–8PubMedCrossRefGoogle Scholar
  5. 5.
    Murphy C, Norman J. The 20% rule: a simple, instantaneous radioactivity defines cure and allows elimination of frozen sections and hormone assays during parathyroidectomy. Surgery 1999; 126:1023–8PubMedCrossRefGoogle Scholar
  6. 6.
    Sidiropoulos N, Vento J, Malchoff C, Whalen G. Radioguided tumorectomy in the management of parathyroid adenomas. Arch Surg 2003; 138:716–20PubMedCrossRefGoogle Scholar
  7. 7.
    McGreal G, Winter DC, Sookhai S, Evoy D, Ryan M, O’Sullivan GC, Redmond HP. Minimally invasive, radioguided surgery for primary hyperparathyroidism. Ann Surg Oncol 2001; 8:856–60PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2007

Authors and Affiliations

  • Brian R. Untch
    • 1
  • Michael E. Barfield
    • 1
  • Joe Bason
    • 1
  • John A. OlsonJr.
    • 1
  1. 1.Department of SurgeryDuke University Medical CenterDurhamUSA

Personalised recommendations