Radio-guided Minimally Invasive Parathyroidectomy: A Descriptive Report of the Experience from Tertiary Center in Bangalore

OVERVIEW: Minimally invasive parathyroidectomy (MIP) is an accepted surgical procedure for parathyroid adenomas. In the patients with parathyroid adenoma localized by dual phase (99m)Tc-Sestamibi scan, a focused approach utilizing the gamma probe intra-operatively helps in ensuring complete resection and avoiding exploration of the other parathyroid glands. OBJECTIVE: The aim of the study was to evaluate the performance of radio-guided MIP for parathyroid adenomas detected by dual phase (99m)Tc-MIBI preoperatively, without intra-operative parathyroid hormone (ioPTH) monitoring for patients who had evidence of single-gland disease. PATIENTS AND METHODS: A retrospective dataset of 30 patients diagnosed with solitary parathyroid adenoma operated between 2009 and 2014 were reviewed. All of the patients underwent radio-guided MIP and were followed up for at least 6 months post-operatively. The biochemical parameters (serum calcium and serum parathyroid hormone levels), imaging parameters (ultrasonography and (99m)Tc-MIBI), and operative times were analyzed. RESULTS: Our study consisted of 30 patients with 50% females, with a mean age of 42.5 + 12 years. The mean surgical duration was 20 + 12 min. All of the patients achieved biochemical cure (normalization of serum calcium) and remained eucalcemic at follow-up. No major surgical complications were noted. CONCLUSIONS: Focused parathyroidectomy using the gamma probe localization could be a potential alternative for ioPTH assay in ensuring the completeness of surgical resection of parathyroid adenoma. It is also likely to shorten operative time.