Targeted Parathyroidectomy in the Era of Intraoperative
Parathormone Monitoring |
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Authors: | William B Inabnet III Gregory F Dakin Richard S Haber Francesco Rubino Ed J Diamond Michel Gagner |
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Institution: | (1) Department of Surgery, The Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, New York 10029, USA, USA;(2) Division of Endocrinology, Department of Medicine, The Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, New York 10029, USA, USA |
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Abstract: | A combination of preoperative
localization and intraoperative parathormone (PTH) monitoring permits
targeted parathyroidectomy. Multiple approaches have been developed,
ranging from unilateral neck exploration (UE) to radio-guided
parathyroidectomy (RP) to endoscopic parathyroidectomy (EP). The
purpose of this study was to evaluate the efficacy of these approaches
in the management of primary hyperparathyroidism. From June 1998 to
November 2000 a total of 110 targeted parathyroid operations were
performed at a university medical center. All patients underwent
technetium-99m-sestamibi scanning, ultrasonography, or both prior to
surgery. Intraoperative PTH monitoring was utilized in all cases.
Thirty-seven patients underwent UE, 59 underwent RP, and 14 underwent
EP. Follow-up ranged from 1 to 24 months. All patients were cured
following parathyroidectomy as predicted by a more than 50% reduction
of the intraoperative PTH level following removal of all hypersecreting
glands. Altogether, 103 patients had a solitary adenoma (95%), and 1
patient had a parathyroid carcinoma. Six patients (5%) had multigland
disease, including four cases of hyperplasia and two patients with a
double adenoma. Eighty-three patients (75%) were discharged the day of
surgery. The use of preoperative localization and intraoperative PTH
monitoring permits a targeted approach to the treatment of primary
hyperparathyroidism. Endocrine surgeons should be facile in all
minimally invasive parathyroid techniques to individualize the
operative approach. |
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