Minimally invasive parathyroidectomy: the role of radio-guided surgery

OBJECTIVES: Objectives were to review our current experience with radio-guided parathyroid surgery and to compare various techniques of minimally invasive parathyroidectomy. STUDY DESIGN: 1) To review our recent experience of radio-guided gamma probe localization during surgery for primary hyperparathyroidism and 2) to compare the intraoperative findings with the preoperative sestamibi scan. METHODS: Analysis was made of the 10 most recent surgical procedures for primary hyperparathyroidism at a single institution to compare the operative localization with preoperative sestamibi scan and to determine the radioactivity in the tissue removed during surgery, such as parathyroid adenoma, normal parathyroid gland, thyroid tissue, or lymph nodes. RESULTS: The sestamibi scan was able to localize the enlarged parathyroid gland in eight patients. Although gamma probe was helpful in localizing the parathyroid gland, the identification of an enlarged parathyroid gland was directly based on the preoperative findings of sestamibi scan. In the remaining two patients, the intraoperative gamma probe was not helpful. CONCLUSIONS: The major advantage of gamma probe in the series was to evaluate the radioactivity in the tissue that was removed and to determine whether it was an enlarged parathyroid gland, lymph node, thyroid tissue, or fatty tissue. The radio-guided surgery did not add substantially to the surgical procedure in patients in whom the sestamibi scan had localized the enlarged parathyroid gland preoperatively.