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William B. Inabnet III, MD; Chun K. Kim, MD; Richard S. Haber, MD; Richard A. Lopchinsky, MD

Arch Surg. 2002;137:967-970.

Background  Improvements in the accuracy of preoperative localization and the availability of the rapid parathyroid hormone assay have permitted minimally invasive parathyroidectomy in patients with primary hyperparathyoidism.

Hypothesis  The use of intraoperative radioguidance is beneficial during targeted parathyroid operations.

Design  A retrospective analysis of a prospective database of patients.

Setting  Tertiary care referral center.

Patients  During a 2-year period, 130 patients underwent minimally invasive, targeted parathyroidectomy with intraoperative monitoring of the parathyroid hormone level. Of these, 60 patients underwent radioguided parathyroidectomy. Prior to surgery, a solitary parathyroid adenoma was visualized on technetium Tc 99m sestamibi scintigraphy in all patients selected for radioguided parathyroidectomy. A gamma probe was used to guide the surgical dissection.

Results  All patients were cured following radioguided parathyroidectomy. In 29 patients (48%), the probe provided confusing or inaccurate information; however, a unilateral neck exploration with excision of a parathyroid adenoma was successfully completed in each of these patients. Forty-three cases were completed under local anesthesia and 85% were discharged home on the same day of surgery. There was 1 temporary recurrent laryngeal nerve palsy.

Conclusion  In the era of improved preoperative localization and intraoperative parathyroid hormone monitoring, the routine use of radioguidance is not recommended during parathyroidectomy.

From the Department of Surgery (Drs Inabnet and Lopchinsky), Division of Nuclear Medicine, Department of Radiology (Dr Kim), and Division of Endocrinology, Department of Medicine (Dr Haber), Mount Sinai School of Medicine, New York, NY.

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