Minimally Invasive Radioguided Parathyroidectomy
Author: Joshua Hagood
Performing surgeon/coauthor: Brendan C. Stack, Jr., M.D., FACS, FACE
Department of Otolaryngology – Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
Overview:
Primary hyperparathyroidism is a disease caused by overproduction of parathyroid hormone (PTH). This condition is most commonly caused by a solitary, hyperfunctioning, adenoma among one of the four parathyroid glands. The hallmark finding of hyperparathyroidism is hypercalcemia which can manifest symptomatically as nephrolithiasis, diabetes insipidus, renal insufficiency, bone pathology, gastrointestinal symptoms, and neuropsychiatric disturbances (remembered as “Stones, Bones, Groans, and Psychiatric overtones”). Minimally invasive Radio guided Parathyroidectomy (MIRP) is a curative procedure for primary hyperparathyroidism that can use both radionuclide guidance and intraoperative PTH measurements to confirm the removal of the offending adenoma. Radionuclide guidance is performed via the injection of 99mTc-sestamibi, which is a radiomarker that sequesters within adenomatous/hypermetabolic parathyroid tissue. Intraoperatively, the amount of 99mTc-sestamibi within excised tissue can be measured with the use of a handheld gamma probe.
Instrumentation:
-Endotracheal Nerve Integrity Monitoring System (NIMS)
-Gamma Probe
-Intraoperative PTH assay equipment