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Intraoperative Parathormone Assay and Radioguided Parathyroidectomy in Patients with Primary Hiperparathyroidism

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Pypkowski J., Dąbrowiecki S., Wierzchowski P., Szmytkowski J., Pilecki S.
Polish Journal of Surgery
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2010
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vol. 82
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issue 1
16-23
EN
The outcome of surgical treatment of primary hyperparathyreoidism (PHP) is largely dependent on the radicality of the operation. This is sometimes difficult due to abnormal location of the glands. The use of intraoperative parathormone assay (IOPTH) and a handheld gamma-ray detector (HGRD) might influence the outcome of treatment.The aim of the study was to assess the feasibility of intraoperative parathormone assay and handheld gamma ray detector in surgical treatment of primary hyperparathyroidism.Material and methods. Prospective analysis of the treatment outcomes of patients with PHP undergoing surgery at the Dept. of General and Endocrine Surgery was accomplished. The patients were divided into two groups: G1 - patients in whom HGRD was used to intraoperatively locate the parathyroid glands; G2 - patients in whom both the HGRD and IOPTH were utilized. In all of the patients preoperative serum calcium and PTH measurements were taken. Thirty minutes before the scheduled start of the operation, patients from both groups received an 800 MBq dose of the Tc-MIBI radiomarker. Gamma radiation measurements were performed with the use of a Gamma Finder handheld device. In patients from the G2 group, serum PTH was assessed 10 minutes after the removal of the last gland. In the G1 group, bilateral neck exploration was performed. In the G2 group, the operation was brought to a close after the Miami criterion was met; in most cases, the surgery was limited to unilateral neck exploration.Results. Between 2007 and 2009 25 patients underwent surgery for PHP (group G1 - 12, group G2 - 13). There was one case of persistent hyperparathyroidism in group G1. All of the parathyroidectomies in group G2 were successful. No difference in the length of hospital stay were noted between the groups. The duration of surgery was longer in group G2.Conclusions. Surgical treatment of PHP with the combined use of a handheld gamma radiation detector and an intraoperative parathormone assay yields satisfactory results despite limited tissue preparation.
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