Pitfalls of Intraoperative Quick Parathyroid Hormone Monitoring and Gamma Probe Localization in Surgery for Primary Hyperparathyroidism

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Abstract
SURGICAL TREATMENT of primary hyperparathyroidism has a high success rate in experienced hands, with major series reporting 95% to 98% cure rates with traditional bilateral neck exploration.1-3 Because failures occur and because of a drive toward cost containment, shorter operative and recovery times, and more minimally invasive procedures, innovations have been investigated in parathyroid surgery. These have included unilateral exploration with guidance by means of a preoperative sestamibi parathyroid scan (SPS),4-6 minimally invasive radio-guided parathyroidectomy using a handheld gamma probe (GP),7-9 and intraoperative quick parathyroid hormone (qPTH) monitoring to demonstrate a rapid decrease in PTH level.10-14 Many reports have been published concerning the utility and the benefits of these various approaches, and many have included warnings of failures using these minimal approaches.15-17 At present, no consensus exists on the best way to approach parathyroidectomy for primary hyperparathyroidism.