Minimally invasive radioguided parathyroidectomy performed for primary hyperparathyroidism

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Abstract
Objective: Parathyroid surgery is often challenging due to considerable variability in anatomy. Minimally invasive radioguided parathyroidectomy (MIRP) is a directed surgical approach that has been made possible by the advent of new imaging techniques, specifically sestamibi scanning. In this study, we review our experience and outcomes with MIRP in one of the largest case series reported in the literature. Study Design: Case series with chart review. Setting: Tertiary care center. Subjects and Methods: Subjects were 305 patients who underwent MIRP in our institution between 1997 and 2007. Data including symptoms, preoperative and postoperative calcium levels, and PTH levels were collected. Analyses were performed using Excel AnalysisPak. Results: MIRP in this series had a 100 percent rate of success in removing a hyperfunctional parathyroid gland. The mean preoperative calcium was 10.9 whereas the mean postoperative level was 9.8. There was a significant difference between preoperative and postoperative calcium levels (both ionized and total) (P < 0.01). Mean preoperative and postoperative serum PTH levels were 138 and 50, respectively. PTH levels were therefore significantly lower postoperatively (P < 0.01). Rapid PTH testing showed a similar pattern. There were no cases of recurrent laryngeal nerve palsy. Conclusion: MIRP is an effective method for removal of image-localized hyperfunctional parathyroid glands.